Healthcare Provider Details

I. General information

NPI: 1013495423
Provider Name (Legal Business Name): PARKVIEW NIAGARA STREET, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 MAIN ST STE 150
AMHERST NY
14226-3350
US

IV. Provider business mailing address

3920 MAIN ST STE 150
AMHERST NY
14226-3350
US

V. Phone/Fax

Practice location:
  • Phone: 716-423-2313
  • Fax: 716-423-2329
Mailing address:
  • Phone: 716-423-2313
  • Fax: 716-423-2329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number036719
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN T WACLAWEK
Title or Position: COO
Credential: PHARMD
Phone: 716-876-2323