Healthcare Provider Details

I. General information

NPI: 1699013003
Provider Name (Legal Business Name): STEPHANIE ALICIA KALISZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 YOUNG ST
TONAWANDA NY
14150-4114
US

IV. Provider business mailing address

78 LAWNWOOD DR
AMHERST NY
14228-1603
US

V. Phone/Fax

Practice location:
  • Phone: 716-692-8286
  • Fax:
Mailing address:
  • Phone: 716-912-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number057036
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: