MEDICARE: DR. BRIAN ROBERT RAGNE 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	059256	NY

General Provider Information

NPI Number	:	1972953826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN ROBERT RAGNE PHARMD

Provider Business Mailing Address
First Line	:	101 S MAIN ST
Second Line	:
City	:	NEWARK
State	:	NY
Zip	:	14513-1418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S MAIN ST
Second Line	:
City	:	NEWARK
State	:	NY
Zip	:	14513-1418
Country	:	US
Telephone Number	:	315-331-2181
Fax Number	:

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

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	06/21/2016

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