Provider Demographics
NPI:1255383782
Name:TORRES, MANDY ROSE (PHARM D, CGP, BCPS)
Entity type:Individual
Prefix:DR
First Name:MANDY
Middle Name:ROSE
Last Name:TORRES
Suffix:
Gender:F
Credentials:PHARM D, CGP, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MANNING BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1738
Mailing Address - Country:US
Mailing Address - Phone:518-626-6065
Mailing Address - Fax:518-626-6075
Practice Address - Street 1:113 HOLLAND AVE
Practice Address - Street 2:(119)
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3410
Practice Address - Country:US
Practice Address - Phone:518-626-6065
Practice Address - Fax:518-626-6075
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256561835G0303X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist