Provider Demographics
NPI:1487939310
Name:BARTLETT-WYNTER, DOCKOTA CLAUDE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DOCKOTA
Middle Name:CLAUDE
Last Name:BARTLETT-WYNTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11804 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1922
Mailing Address - Country:US
Mailing Address - Phone:134-786-5888
Mailing Address - Fax:
Practice Address - Street 1:11804 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1922
Practice Address - Country:US
Practice Address - Phone:134-786-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562691183500000X
CT0011393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist