Healthcare Provider Details

I. General information

NPI: 1841211802
Provider Name (Legal Business Name): GENESEE VALLEY GROUP HEALTH ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 MAIN ST
BUFFALO NY
14203-1109
US

IV. Provider business mailing address

1185 SWEET HOME RD
AMHERST NY
14226-1018
US

V. Phone/Fax

Practice location:
  • Phone: 716-885-2833
  • Fax: 716-422-2808
Mailing address:
  • Phone: 716-689-3420
  • Fax: 716-689-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number027323
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPH29885
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN URBANSKI
Title or Position: MANAGER, PHARMACY SERVICES
Credential: RPH
Phone: 716-689-3420