Provider Demographics
NPI:1922284058
Name:BAIN, DOUGLAS KRISTEN
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:KRISTEN
Last Name:BAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 THRUWAY PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4940
Mailing Address - Country:US
Mailing Address - Phone:716-896-3708
Mailing Address - Fax:716-896-3747
Practice Address - Street 1:100 THRUWAY PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4940
Practice Address - Country:US
Practice Address - Phone:716-896-3708
Practice Address - Fax:716-896-3747
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist