Healthcare Provider Details

I. General information

NPI: 1922768621
Provider Name (Legal Business Name): ERIE COUNTY MEDICAL CENTER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST RM 111-02D
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

462 GRIDER ST RM 111-02D
BUFFALO NY
14215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-3727
  • Fax:
Mailing address:
  • Phone: 716-898-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NICOLETTE WILSON
Title or Position: VICE PRESIDENT REVENUE CYCLE
Credential:
Phone: 716-898-3735