Healthcare Provider Details

I. General information

NPI: 1962734566
Provider Name (Legal Business Name): JENNIFER ANN PRUETZ PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3865 UNION RD
CHEEKTOWAGA NY
14225-4211
US

IV. Provider business mailing address

186 THREE ROD RD
ALDEN NY
14004-8835
US

V. Phone/Fax

Practice location:
  • Phone: 716-684-5961
  • Fax: 716-681-1240
Mailing address:
  • Phone: 716-937-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048151-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: