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General NPI Number Information
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NPI Number | 1730369737
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Entity Type | Individual
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Provider Name | J GAGE MORAN RPH
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Gender | Female
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 128 N CENTER ST
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City | PERRY
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State | NY
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Zip | 14530-9701
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Country | US
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Telephone | 585-237-3113
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Fax |
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Provider Business Mailing Address
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Address Line | 4944 PINELEDGE DR N
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City | CLARENCE
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State | NY
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Zip | 14031-1532
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Country | US
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Telephone | 716-759-8277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 041399
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License Number State | NY
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