Provider Demographics
NPI:1104000850
Name:KRAMER, MICHAEL JONATHAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:KRAMER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E SCHUYLER ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13309-1104
Mailing Address - Country:US
Mailing Address - Phone:315-942-4476
Mailing Address - Fax:315-942-4886
Practice Address - Street 1:102 E SCHUYLER ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309-1104
Practice Address - Country:US
Practice Address - Phone:315-942-4476
Practice Address - Fax:315-942-4886
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist