MEDICARE: LOCKPORT PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417950072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOCKPORT PHARMACY INC

Provider Business Mailing Address
First Line	:	21 MAIN ST
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-3626
Country	:	US
Telephone Number	:	716-433-8735
Fax Number	:	716-433-0840

Provider Business Practice Location Address
First Line	:	21 MAIN ST
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-3626
Country	:	US
Telephone Number	:	716-433-8735
Fax Number	:	716-433-0840

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEPHEN GIROUX
Credential	:	RPH
Telephone Number	:	716-735-3261

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/21/2022

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Directions to “LOCKPORT PHARMACY INC ” Practice Location

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