Healthcare Provider Details

I. General information

NPI: 1356629547
Provider Name (Legal Business Name): MRS. KATHLEEN MARY HAYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

IV. Provider business mailing address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

V. Phone/Fax

Practice location:
  • Phone: 716-828-2517
  • Fax: 716-828-2511
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number034327-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: