Healthcare Provider Details

I. General information

NPI: 1275655672
Provider Name (Legal Business Name): SUZANNE B KUCZKA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 NIAGARA FALLS BLVD
AMHERST NY
14228-2705
US

IV. Provider business mailing address

1701 NIAGARA FALLS BLVD
AMHERST NY
14228-2705
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-0475
  • Fax: 716-862-0917
Mailing address:
  • Phone: 716-862-0475
  • Fax: 716-862-0917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040614
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: