Healthcare Provider Details

I. General information

NPI: 1205176211
Provider Name (Legal Business Name): WURLITZER FAMILY PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 DIVISION ST
NORTH TONAWANDA NY
14120-4403
US

IV. Provider business mailing address

521 DIVISION ST
NORTH TONAWANDA NY
14120-4403
US

V. Phone/Fax

Practice location:
  • Phone: 716-260-1131
  • Fax: 716-260-1132
Mailing address:
  • Phone: 716-260-1131
  • Fax: 716-260-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number031707
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number031707
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number031707
License Number StateNY

VIII. Authorized Official

Name: ZACHARY GIROUX
Title or Position: CFO/OWNER
Credential:
Phone: 716-260-1131