Healthcare Provider Details

I. General information

NPI: 1497077325
Provider Name (Legal Business Name): MICHAEL E. KOLMAN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 WINDSOR HWY SUITE 100
VAILS GATE NY
12584
US

IV. Provider business mailing address

3 BIANCA BLVD
CHESTER NY
10918-1461
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-1320
  • Fax: 845-561-1986
Mailing address:
  • Phone: 845-610-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040894
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: