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Provider Information for 1013495423


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PARKVIEW NIAGARA STREET, LLC

Other Names:  
Doing Business As: 
RIVERVIEW PROFESSIONAL PHARMACY

Organization Subpart: NO

NPI: 1013495423
Last Updated: 2024-08-07
Certification Date: 2024-08-07

Details

NameValue
NPI1013495423
Enumeration Date2018-07-30
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: Mr. JUSTIN T WACLAWEK PharmD
Title: COO
Phone: 7168762323
Mailing Address 3920 MAIN ST STE 150
AMHERST, NY 14226-3350
United States

Phone: 716-423-2313 | Fax:716-423-2329
 
Primary Practice Address 3920 MAIN ST STE 150
AMHERST, NY 14226-3350
United States

Phone: 716-423-2313 | Fax:716-423-2329
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)NY036719State Pharmacy Registration
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 3336I0012X - Pharmacy - Institutional Pharmacy
Yes 3336L0003X - Pharmacy - Long Term Care PharmacyNY036719
No 3336S0011X - Pharmacy - Specialty Pharmacy