Healthcare Provider Details

I. General information

NPI: 1881609410
Provider Name (Legal Business Name): LAKEWOOD APOTHECARY AND NATURAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CHAUTAUQUA AVE
LAKEWOOD NY
14750-1241
US

IV. Provider business mailing address

130 CHAUTAUQUA AVE
LAKEWOOD NY
14750-1241
US

V. Phone/Fax

Practice location:
  • Phone: 716-763-0016
  • Fax: 716-763-0076
Mailing address:
  • Phone: 716-763-0016
  • Fax: 716-763-0076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027528
License Number StateNY

VIII. Authorized Official

Name: JAMES ROUEGNO
Title or Position: OWNER/PRESIDENT
Credential: RPH
Phone: 716-763-0016