Provider Demographics
NPI:1720105141
Name:SURIN, MICHAEL JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:SURIN
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 1:138 COUNTRY WALK RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-6709
Mailing Address - Country:US
Mailing Address - Phone:518-458-1030
Mailing Address - Fax:518-482-1839
Practice Address - Street 1:490 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1589
Practice Address - Country:US
Practice Address - Phone:518-458-1030
Practice Address - Fax:518-482-1839
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist