Provider Demographics
NPI:1265036123
Name:CRONAUER, MATTHEW ALAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
Last Name:CRONAUER
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 1:5767 BROADACRES RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6215
Mailing Address - Country:US
Mailing Address - Phone:315-520-6223
Mailing Address - Fax:
Practice Address - Street 1:338 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1024
Practice Address - Country:US
Practice Address - Phone:607-776-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist