Provider Demographics
NPI:1871704940
Name:AGOVINO, MICHAEL A
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:AGOVINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ABBEY PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1715
Mailing Address - Country:US
Mailing Address - Phone:845-494-2149
Mailing Address - Fax:718-543-1071
Practice Address - Street 1:1 ABBEY PL
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1715
Practice Address - Country:US
Practice Address - Phone:845-494-2149
Practice Address - Fax:718-543-1071
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027823OtherPHARMACIST LICENSE