Provider Demographics
NPI:1811509797
Name:FLEMING, DAMIAN F (PHARM D)
Entity type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:F
Last Name:FLEMING
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BALSAM AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-4723
Mailing Address - Country:US
Mailing Address - Phone:518-708-3161
Mailing Address - Fax:
Practice Address - Street 1:4357 NY HIGHWAY 150
Practice Address - Street 2:
Practice Address - City:WEST SAND LAKE
Practice Address - State:NY
Practice Address - Zip Code:12196-1936
Practice Address - Country:US
Practice Address - Phone:518-674-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066813-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist