Provider Demographics
NPI:1538348818
Name:GAUTHIER, MICHAEL P (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7361 OWASCO RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-5111
Mailing Address - Country:US
Mailing Address - Phone:315-255-1761
Mailing Address - Fax:315-255-2152
Practice Address - Street 1:352 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3126
Practice Address - Country:US
Practice Address - Phone:315-255-1761
Practice Address - Fax:315-255-2152
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist