Healthcare Provider Details

I. General information

NPI: 1609151034
Provider Name (Legal Business Name): KRISTEN DANIELLE WUDYKA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MAIN ST STE 100
BUFFALO NY
14202-1102
US

IV. Provider business mailing address

296 WALTON DR
AMHERST NY
14226-4835
US

V. Phone/Fax

Practice location:
  • Phone: 716-541-1994
  • Fax: 716-541-1996
Mailing address:
  • Phone: 716-310-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55126
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: