Healthcare Provider Details

I. General information

NPI: 1083157036
Provider Name (Legal Business Name): ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO NY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 JOHN JAMES AUDUBON PKWY STE 101
AMHERST NY
14228-1183
US

IV. Provider business mailing address

13410 EASTPOINT CENTRE DR STE 100
LOUISVILLE KY
40223-4160
US

V. Phone/Fax

Practice location:
  • Phone: 877-662-6633
  • Fax: 877-662-6355
Mailing address:
  • Phone: 877-662-6633
  • Fax: 502-849-0643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number030717
License Number StateNY

VIII. Authorized Official

Name: AMY KONAK
Title or Position: VP, REIMBURSEMENT REVENUE CYCLE MGT
Credential:
Phone: 877-662-6633