Healthcare Provider Details

I. General information

NPI: 1891848545
Provider Name (Legal Business Name): FORSTER'S PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 S PARK AVE
BLASDELL NY
14219-1129
US

IV. Provider business mailing address

3713 S PARK AVE
BLASDELL NY
14219-1129
US

V. Phone/Fax

Practice location:
  • Phone: 716-823-9800
  • Fax: 716-823-6433
Mailing address:
  • Phone: 716-823-9800
  • Fax: 716-823-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number019219
License Number StateNY

VIII. Authorized Official

Name: DONALD S. DALY
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 716-823-9800