Provider Demographics
NPI:1255663845
Name:ANSON, MICHAEL JR (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ANSON
Suffix:JR
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 1:2066 ROUTE 32
Mailing Address - Street 2:HANNAFORD FOOD & DRUG PHARMACY #8346
Mailing Address - City:MODENA
Mailing Address - State:NY
Mailing Address - Zip Code:12548
Mailing Address - Country:US
Mailing Address - Phone:845-883-7469
Mailing Address - Fax:
Practice Address - Street 1:2066 ROUTE 32
Practice Address - Street 2:HANNAFORD FOOD & DRUG PHARMACY #8346
Practice Address - City:MODENA
Practice Address - State:NY
Practice Address - Zip Code:12548
Practice Address - Country:US
Practice Address - Phone:845-883-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist