Healthcare Provider Details

I. General information

NPI: 1962453282
Provider Name (Legal Business Name): GARY ANTHONY ROTELLA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 TRANSIT RD
DEPEW NY
14043-1096
US

IV. Provider business mailing address

45 REHM RD
LANCASTER NY
14086-1067
US

V. Phone/Fax

Practice location:
  • Phone: 716-601-0183
  • Fax:
Mailing address:
  • Phone: 716-681-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number036421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: