Provider Demographics
NPI:1265101232
Name:AUSTIN, MICHAEL DENNIS (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DENNIS
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 LISBON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1404
Mailing Address - Country:US
Mailing Address - Phone:585-472-4253
Mailing Address - Fax:
Practice Address - Street 1:1460 S PARK AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1041
Practice Address - Country:US
Practice Address - Phone:716-515-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist