Provider Demographics
NPI:1942483508
Name:BO, TINA TRUC (PHARMD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:TRUC
Last Name:BO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:56 W MERRITT BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2243
Mailing Address - Country:US
Mailing Address - Phone:845-896-8665
Mailing Address - Fax:845-896-8528
Practice Address - Street 1:56 W MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2243
Practice Address - Country:US
Practice Address - Phone:845-896-8665
Practice Address - Fax:845-896-8528
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist