Healthcare Provider Details

I. General information

NPI: 1134813454
Provider Name (Legal Business Name): WURLITZER FAMILY PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
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 TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY GIROUX
Title or Position: CHIEF FINANICAL OFFICER
Credential:
Phone: 716-260-1131