Healthcare Provider Details

I. General information

NPI: 1649797879
Provider Name (Legal Business Name): KIMBERLY ANN DEPCZYNSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 MEADOW DR
NORTH TONAWANDA NY
14120-2815
US

IV. Provider business mailing address

343 MEADOW DR
NORTH TONAWANDA NY
14120-2815
US

V. Phone/Fax

Practice location:
  • Phone: 716-694-2001
  • Fax: 716-694-6771
Mailing address:
  • Phone: 716-694-2001
  • Fax: 716-694-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number063302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: