Healthcare Provider Details

I. General information

NPI: 1508561572
Provider Name (Legal Business Name): KACEY MARIE OWENS CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S ERIE ST
MAYVILLE NY
14757-1110
US

IV. Provider business mailing address

40 S ERIE ST
MAYVILLE NY
14757-1110
US

V. Phone/Fax

Practice location:
  • Phone: 716-753-7221
  • Fax: 716-753-7129
Mailing address:
  • Phone: 716-753-7221
  • Fax: 716-753-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: