Active NPI
Lacy Ann Mulder, RPH
- Pharmacist
- Amsterdam, NY
National Provider Identifier
1174857155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 053973-1
- Practice address
- 101 Sanford Farms Shopping Ctr
Amsterdam, NY 12010-7535 - Phone
- (518) 843-6895
- NPI assigned
- Sep 24, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 053973-1 | NY | Primary |
Addresses
Primary practice location
101 Sanford Farms Shopping Ctr
Amsterdam, NY 12010-7535
Mailing address
12 W Liberty St
Saint Johnsville, NY 13452-1218
Phone (518) 222-1189
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 053973-1 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253750400000",
"number": "1174857155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 W LIBERTY ST",
"city": "SAINT JOHNSVILLE",
"state": "NY",
"postal_code": "134521218",
"telephone_number": "518-222-1189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 SANFORD FARMS SHOPPING CTR",
"city": "AMSTERDAM",
"state": "NY",
"postal_code": "120107535",
"telephone_number": "518-843-6895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULDER",
"first_name": "LACY",
"middle_name": "ANN",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-24",
"last_updated": "2009-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "053973-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amsterdam, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.