Provider Demographics
NPI:1356665442
Name:MCMONAGLE, JAMES N (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:N
Last Name:MCMONAGLE
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 1:1200 STATE ROUTE 208
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4648
Mailing Address - Country:US
Mailing Address - Phone:845-782-2260
Mailing Address - Fax:845-783-9295
Practice Address - Street 1:1200 STATE ROUTE 208
Practice Address - Street 2:SUITE 1
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4648
Practice Address - Country:US
Practice Address - Phone:845-782-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01172141Medicaid