Healthcare Provider Details

I. General information

NPI: 1124143672
Provider Name (Legal Business Name): CHRISTEN MARY KIRK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 JEFFERSON AVE
BUFFALO NY
14208-2126
US

IV. Provider business mailing address

69 CHIPPEWA CT
WEST SENECA NY
14224-4722
US

V. Phone/Fax

Practice location:
  • Phone: 716-816-0190
  • Fax:
Mailing address:
  • Phone: 716-479-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041363
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: