Provider Demographics
NPI:1104080415
Name:DRAGONE, KATHLEEN MARIE (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:DRAGONE
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 1:7115 NORTH MAIN ST
Mailing Address - Street 2:P.O.
Mailing Address - City:OVID
Mailing Address - State:NY
Mailing Address - Zip Code:14521
Mailing Address - Country:US
Mailing Address - Phone:607-869-5033
Mailing Address - Fax:607-869-5252
Practice Address - Street 1:7115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:NY
Practice Address - Zip Code:14521-0369
Practice Address - Country:US
Practice Address - Phone:607-869-5033
Practice Address - Fax:607-869-5252
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist