Healthcare Provider Details

I. General information

NPI: 1417080011
Provider Name (Legal Business Name): IAN ADAM LEBERMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 TRANSIT RD
DEPEW NY
14043-4772
US

IV. Provider business mailing address

6913 KIMBERLY DR
LOCKPORT NY
14094-9094
US

V. Phone/Fax

Practice location:
  • Phone: 716-515-3290
  • Fax: 716-515-3294
Mailing address:
  • Phone: 716-799-2899
  • Fax: 716-515-3294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: