Provider Demographics
NPI:1932387107
Name:ALDI, ELIZABETH B (RPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:ALDI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:NY
Mailing Address - Zip Code:12170-1331
Mailing Address - Country:US
Mailing Address - Phone:518-664-4234
Mailing Address - Fax:
Practice Address - Street 1:675 TROY SCHENECTADY RD
Practice Address - Street 2:TARGET PHARMACY T-1915
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2493
Practice Address - Country:US
Practice Address - Phone:518-782-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02852711Medicaid