Provider Demographics
NPI:1215481775
Name:BAIN, MEGAN LAURA (PHARMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LAURA
Last Name:BAIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-6109
Mailing Address - Country:US
Mailing Address - Phone:518-692-3177
Mailing Address - Fax:
Practice Address - Street 1:1165 STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-6109
Practice Address - Country:US
Practice Address - Phone:518-692-3177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist