Provider Demographics
NPI:1295878528
Name:PAGNOTTA, PAUL B (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:B
Last Name:PAGNOTTA
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 1:340 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1918
Mailing Address - Country:US
Mailing Address - Phone:518-439-8200
Mailing Address - Fax:518-439-3657
Practice Address - Street 1:340 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1918
Practice Address - Country:US
Practice Address - Phone:518-439-8200
Practice Address - Fax:518-439-3657
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041386OtherNYS PHARMACY LICENSE