Provider Demographics
NPI:1326327339
Name:JAGORD, RONALD
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:JAGORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 TWO ROD RD
Mailing Address - Street 2:
Mailing Address - City:MARILLA
Mailing Address - State:NY
Mailing Address - Zip Code:14102-9729
Mailing Address - Country:US
Mailing Address - Phone:716-655-3085
Mailing Address - Fax:
Practice Address - Street 1:22 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036
Practice Address - Country:US
Practice Address - Phone:585-599-4563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist