Provider Demographics
NPI:1720312887
Name:AVERY, PETER MARK (PHARM D)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MARK
Last Name:AVERY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9559
Mailing Address - Country:US
Mailing Address - Phone:518-869-1520
Mailing Address - Fax:518-869-1574
Practice Address - Street 1:2061 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-9559
Practice Address - Country:US
Practice Address - Phone:518-869-1520
Practice Address - Fax:518-869-1574
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist