Provider Demographics
NPI:1801079199
Name:AGNE, MICHAEL WILLIAM (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:AGNE
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 1:279 TROY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9499
Mailing Address - Country:US
Mailing Address - Phone:518-283-3021
Mailing Address - Fax:
Practice Address - Street 1:279 TROY RD STE 100
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9499
Practice Address - Country:US
Practice Address - Phone:518-283-3021
Practice Address - Fax:518-283-3031
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist