Healthcare Provider Details

I. General information

NPI: 1821270117
Provider Name (Legal Business Name): JASON ALAN FOLCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 HOPKINS RD
WILLIAMSVILLE NY
14221-1752
US

IV. Provider business mailing address

8933 CONNEMARA LN
CLARENCE CENTER NY
14032-9513
US

V. Phone/Fax

Practice location:
  • Phone: 716-568-0075
  • Fax:
Mailing address:
  • Phone: 716-741-8970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: