Provider Demographics
NPI:1285956599
Name:GAGNON, STEPHEN MICHEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHEL
Last Name:GAGNON
Suffix:
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 1:203 VISCHER FERRY RD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1620
Mailing Address - Country:US
Mailing Address - Phone:518-727-7838
Mailing Address - Fax:
Practice Address - Street 1:839 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3861
Practice Address - Country:US
Practice Address - Phone:518-371-3700
Practice Address - Fax:518-371-7103
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49622183500000X
NY053521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist