Provider Demographics
NPI:1013075910
Name:MAGGY, MARK KENNEDY (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:KENNEDY
Last Name:MAGGY
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 1:58 GREENBRIAR WAY
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-4124
Mailing Address - Country:US
Mailing Address - Phone:518-562-0170
Mailing Address - Fax:
Practice Address - Street 1:1165 RT 374
Practice Address - Street 2:
Practice Address - City:DANNEMORA
Practice Address - State:NY
Practice Address - Zip Code:12929-0369
Practice Address - Country:US
Practice Address - Phone:518-492-7130
Practice Address - Fax:518-492-7311
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist