Healthcare Provider Details

I. General information

NPI: 1629674288
Provider Name (Legal Business Name): MARY J HEJNA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 MAPLE RD
AMHERST NY
14221-3647
US

IV. Provider business mailing address

906 WOODSTOCK AVE
TONAWANDA NY
14150-5540
US

V. Phone/Fax

Practice location:
  • Phone: 716-568-3850
  • Fax: 716-568-3115
Mailing address:
  • Phone: 716-603-3130
  • Fax: 716-568-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number066946
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: