Healthcare Provider Details

I. General information

NPI: 1730014655
Provider Name (Legal Business Name): KYLE DIEROLF PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4328 S BUFFALO ST
ORCHARD PARK NY
14127-2695
US

IV. Provider business mailing address

60 HENRY DR
ELMA NY
14059-9512
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073819
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: