Healthcare Provider Details

I. General information

NPI: 1679587554
Provider Name (Legal Business Name): KENNETH M JAROSZ SR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 W MAIN ST
BATAVIA NY
14020-1240
US

IV. Provider business mailing address

165 SCHWARTZ RD
LANCASTER NY
14086-9605
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-0252
  • Fax:
Mailing address:
  • Phone: 716-681-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number036539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: