Healthcare Provider Details

I. General information

NPI: 1982924825
Provider Name (Legal Business Name): MRS. KATHLEEN VICTORIA LEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 BURKE DR
BUFFALO NY
14215-1305
US

IV. Provider business mailing address

45 BURKE DR.
BUFFALO NY
14215
US

V. Phone/Fax

Practice location:
  • Phone: 716-834-1117
  • Fax:
Mailing address:
  • Phone: 716-834-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number032590-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: