Healthcare Provider Details

I. General information

NPI: 1780735969
Provider Name (Legal Business Name): PATRICK JAMES MOOREHEAD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4328 S BUFFALO ST
ORCHARD PARK NY
14127-2638
US

IV. Provider business mailing address

7498 LOWER EAST HILL RD
COLDEN NY
14033-9754
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-3800
  • Fax: 716-662-3676
Mailing address:
  • Phone: 716-941-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046155
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: