Individual
CLEANN TONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
11050 MOUNT BELVEDERE BLVD, FORT DRUM, NY 13602-5438
(315) 772-3696
Mailing address
11050 MOUNT BELVEDERE BLVD, FORT DRUM, NY 13602-5438
(315) 772-3696
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
46252
TX
183500000X
Pharmacist
Primary
I-059996
NY
183500000X
Pharmacist
PH4536
HI
Other
Enumeration date
06/21/2012
Last updated
08/03/2023
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