Provider Demographics
NPI:1285740837
Name:MONTAGNA, COREEN RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COREEN
Middle Name:RENEE
Last Name:MONTAGNA
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 1:146 JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-3209
Mailing Address - Country:US
Mailing Address - Phone:716-773-8940
Mailing Address - Fax:
Practice Address - Street 1:205 PARK CLUB LN
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-5239
Practice Address - Country:US
Practice Address - Phone:716-857-6243
Practice Address - Fax:716-857-6336
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist