Provider Demographics
NPI:1083893903
Name:PAGOREK, ANGELA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:PAGOREK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5399 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2265
Mailing Address - Country:US
Mailing Address - Phone:315-487-6714
Mailing Address - Fax:
Practice Address - Street 1:5399 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2265
Practice Address - Country:US
Practice Address - Phone:315-487-6714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-27
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist