Active NPI
Kimberly Eileen Laurenzo
- Pharmacist
- Rensselaer, NY
National Provider Identifier
1861713794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 054507
- Practice address
- 625 3Rd Ave Ext
Target Pharmacy T-1796
Rensselaer, NY 12144-5618 - Phone
- (518) 283-2572
- Fax
- (518) 238-6204
- NPI assigned
- Jun 15, 2010
- Sex
- Female
- Sole proprietor
- No
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 | 054507 | NY | Primary |
Addresses
Primary practice location
625 3Rd Ave Ext
Target Pharmacy T-1796
Rensselaer, NY 12144-5618
Mailing address
7 Antoinette Lane
Albany, NY 12205
Phone (518) 435-5420
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 054507 | Other | NY | NEW YORK STATE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 054507 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330560000000",
"number": "1861713794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 ANTOINETTE LANE",
"city": "ALBANY",
"state": "NY",
"postal_code": "12205",
"telephone_number": "518-435-5420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 3RD AVE EXT",
"address_2": "TARGET PHARMACY T-1796",
"city": "RENSSELAER",
"state": "NY",
"postal_code": "121445618",
"telephone_number": "518-283-2572",
"fax_number": "518-238-6204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAURENZO",
"first_name": "KIMBERLY",
"middle_name": "EILEEN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-15",
"last_updated": "2012-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "054507",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE",
"identifier": "054507",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rensselaer, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.