Provider Demographics
NPI:1730369737
Name:MORAN, J GAGE (RPH)
Entity type:Individual
Prefix:
First Name:J GAGE
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 PINELEDGE DR N
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1532
Mailing Address - Country:US
Mailing Address - Phone:716-759-8277
Mailing Address - Fax:
Practice Address - Street 1:128 N CENTER ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:NY
Practice Address - Zip Code:14530-9701
Practice Address - Country:US
Practice Address - Phone:585-237-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist