Healthcare Provider Details

I. General information

NPI: 1588863336
Provider Name (Legal Business Name): NANCY JANE VACCARE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PARK CLUB LN
BUFFALO NY
14221-5239
US

IV. Provider business mailing address

205 PARK CLUB LN
BUFFALO NY
14221-5239
US

V. Phone/Fax

Practice location:
  • Phone: 716-504-5557
  • Fax:
Mailing address:
  • Phone: 716-504-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043273
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: