MEDICARE: MICHAEL LARRY KRUGER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051493	NY

General Provider Information

NPI Number	:	1245419530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LARRY KRUGER PHARMD

Provider Business Mailing Address
First Line	:	1624 MAIN ST
Second Line	:
City	:	ROTTERDAM JUNCTION
State	:	NY
Zip	:	12150
Country	:	US
Telephone Number	:	518-852-5363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 STATE ST
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12304-2610
Country	:	US
Telephone Number	:	518-382-1239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/02/2007

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