Provider Demographics
NPI:1144977877
Name:PINTADO MORA, INES
Entity type:Individual
Prefix:
First Name:INES
Middle Name:
Last Name:PINTADO MORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 VANDENBURGH PL APT B
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6048
Mailing Address - Country:US
Mailing Address - Phone:347-848-2672
Mailing Address - Fax:
Practice Address - Street 1:1863 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4221
Practice Address - Country:US
Practice Address - Phone:518-456-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician