Provider Demographics
NPI:1124801626
Name:STAGE, PAUL OTTO II (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:OTTO
Last Name:STAGE
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2518
Mailing Address - Country:US
Mailing Address - Phone:716-397-7669
Mailing Address - Fax:
Practice Address - Street 1:9 ROYCROFT PKWY
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9316
Practice Address - Country:US
Practice Address - Phone:716-980-0100
Practice Address - Fax:716-980-0104
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0706031835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care