Healthcare Provider Details

I. General information

NPI: 1518845635
Provider Name (Legal Business Name): RED FOX PHARMACY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 S TRANSIT ST
LOCKPORT NY
14094-4852
US

IV. Provider business mailing address

5345 E RIVER RD
GRAND ISLAND NY
14072-1132
US

V. Phone/Fax

Practice location:
  • Phone: 716-201-1680
  • Fax: 716-201-1572
Mailing address:
  • Phone: 716-225-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CYRUS ARDALAN
Title or Position: OWNER
Credential:
Phone: 716-796-5668