Healthcare Provider Details

I. General information

NPI: 1205157153
Provider Name (Legal Business Name): SPECIALTY PHARMACY MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 EARHART DRIVE STE 101
AMHERST NY
14221
US

IV. Provider business mailing address

15 EARHART DRIVE STE 101
AMHERST NY
14221
US

V. Phone/Fax

Practice location:
  • Phone: 716-929-1000
  • Fax: 716-532-7360
Mailing address:
  • Phone: 716-929-1000
  • Fax: 716-532-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number030138
License Number StateNY

VIII. Authorized Official

Name: JOHN RODGERS
Title or Position: EVP-CHIEF OPERATING OFFICER
Credential: RPH
Phone: 716-631-3001