Healthcare Provider Details

I. General information

NPI: 1710352257
Provider Name (Legal Business Name): RANDY GERWITZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

673 SARA CT
LEWISTON NY
14092-2344
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-3285
  • Fax:
Mailing address:
  • Phone: 716-868-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038657-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: