Healthcare Provider Details

I. General information

NPI: 1033855044
Provider Name (Legal Business Name): BRIAN BUTTAGGI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SENECA ST STE 602
BUFFALO NY
14210-1351
US

IV. Provider business mailing address

4 PINE MEADOW DR
PENFIELD NY
14526-9511
US

V. Phone/Fax

Practice location:
  • Phone: 716-541-0273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068191
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: