Provider Demographics
NPI:1891192977
Name:GARDINIER, MICHAELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:GARDINIER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1130
Mailing Address - Country:US
Mailing Address - Phone:315-868-6049
Mailing Address - Fax:
Practice Address - Street 1:4855 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-736-8447
Practice Address - Fax:315-736-8778
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI059495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist