Provider Information for 1013495423
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PARKVIEW NIAGARA STREET, LLC
Other Names:Doing Business As:RIVERVIEW PROFESSIONAL PHARMACYOrganization Subpart: NO
NPI: 1013495423
Last Updated: 2024-08-07
Certification Date: 2024-08-07
Certification Date: 2024-08-07
Details
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NPI | 1013495423 | ||||||||||||||||
Enumeration Date | 2018-07-30 | ||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||
Status | Active | ||||||||||||||||
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 | ||||||||||||||||
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