Healthcare Provider Details

I. General information

NPI: 1902830516
Provider Name (Legal Business Name): TLC HEALTH NETWORK OUTPATIENT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 ROUTES 5 & 20
IRVING NY
14081
US

IV. Provider business mailing address

845 ROUTES 5 & 20
IRVING NY
14081
US

V. Phone/Fax

Practice location:
  • Phone: 716-951-7260
  • Fax: 716-951-7262
Mailing address:
  • Phone: 716-951-7260
  • Fax: 716-951-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number025264
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number025264
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number025264
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number025264
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number025264
License Number StateNY

VIII. Authorized Official

Name: MR. ERIC STURM
Title or Position: DIRECTOR OF PHARMACY
Credential: R.PH.
Phone: 716-951-7261