Provider Demographics
NPI:1366693152
Name:COURNEEN, KIRK WILLIAM (RPH)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:WILLIAM
Last Name:COURNEEN
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 1:209 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5062
Mailing Address - Country:US
Mailing Address - Phone:518-423-9541
Mailing Address - Fax:
Practice Address - Street 1:1892 CENTRAL AVE
Practice Address - Street 2:PRICE CHOPPER
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-456-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01039638Medicaid