Provider Demographics
NPI:1659596815
Name:NAGENGAST, VINCENT D (RPH)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:D
Last Name:NAGENGAST
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 1:11 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4205
Mailing Address - Country:US
Mailing Address - Phone:518-885-7560
Mailing Address - Fax:518-792-0598
Practice Address - Street 1:161 CAREY RD
Practice Address - Street 2:KINNEY DRUGS
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-7883
Practice Address - Country:US
Practice Address - Phone:518-480-0011
Practice Address - Fax:518-792-0598
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist