Healthcare Provider Details

I. General information

NPI: 1821311929
Provider Name (Legal Business Name): THADDEUS JOSEPH KUZNIAREK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N AMERICA DR SUITE 100
WEST SENECA NY
14224-2225
US

IV. Provider business mailing address

40 N AMERICA DR SUITE 100
WEST SENECA NY
14224-2225
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-3784
  • Fax: 716-675-7777
Mailing address:
  • Phone: 716-675-3784
  • Fax: 716-675-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038096
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: