Provider Demographics
NPI:1407178346
Name:GIORDANO, MICHAEL V (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:GIORDANO
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:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-0557
Mailing Address - Country:US
Mailing Address - Phone:845-677-3223
Mailing Address - Fax:845-677-3225
Practice Address - Street 1:3272 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-5975
Practice Address - Country:US
Practice Address - Phone:845-677-3223
Practice Address - Fax:845-677-3225
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0033121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00972541Medicaid