Provider Demographics
NPI:1811973159
Name:TOWN TOTAL ALBANY, LLC
Entity type:Organization
Organization Name:TOWN TOTAL ALBANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-257-7294
Mailing Address - Street 1:350 NORTHERN BLVD
Mailing Address - Street 2:SUITE 328
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1000
Mailing Address - Country:US
Mailing Address - Phone:518-257-7294
Mailing Address - Fax:518-257-7299
Practice Address - Street 1:350 NORTHERN BLVD
Practice Address - Street 2:SUITE 328
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1000
Practice Address - Country:US
Practice Address - Phone:518-257-7294
Practice Address - Fax:518-257-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02520056Medicaid
NY5119970001Medicare ID - Type Unspecified