Healthcare Provider Details

I. General information

NPI: 1134197270
Provider Name (Legal Business Name): MR. ALAN R BILICKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 MAPLE RIDGE RD
MEDINA NY
14103-1844
US

IV. Provider business mailing address

11200 MAPLE RIDGE RD
MEDINA NY
14103-1844
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-1629
  • Fax: 855-331-9044
Mailing address:
  • Phone: 585-798-1629
  • Fax: 855-331-9044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number037354
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: