Provider Demographics
NPI:1568664191
Name:BRIGGS, WAYNE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17-21 NO. PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-0000
Mailing Address - Country:US
Mailing Address - Phone:518-434-6024
Mailing Address - Fax:518-626-0859
Practice Address - Street 1:17-21 N. PEARL STREET
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207
Practice Address - Country:US
Practice Address - Phone:518-434-6024
Practice Address - Fax:518-626-0859
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05053425Medicaid
NY050302OtherPHARMACIST