Provider Demographics
NPI:1245419530
Name:KRUGER, MICHAEL LARRY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LARRY
Last Name:KRUGER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROTTERDAM JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12150
Mailing Address - Country:US
Mailing Address - Phone:518-852-5363
Mailing Address - Fax:
Practice Address - Street 1:1108 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2610
Practice Address - Country:US
Practice Address - Phone:518-382-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist