Healthcare Provider Details

I. General information

NPI: 1740509330
Provider Name (Legal Business Name): MISS AMANDA ROSE GUELI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2010
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1230
US

IV. Provider business mailing address

3201 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1230
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-4958
  • Fax: 855-331-9007
Mailing address:
  • Phone: 716-675-4958
  • Fax: 855-331-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number083637
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: