Provider Demographics
NPI:1639491087
Name:MONTGOMERY, PATRICK ERNEST (RPH)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ERNEST
Last Name:MONTGOMERY
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 1:36 S LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2710
Mailing Address - Country:US
Mailing Address - Phone:315-255-2745
Mailing Address - Fax:
Practice Address - Street 1:36 S LEWIS ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2710
Practice Address - Country:US
Practice Address - Phone:315-255-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY40940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist