Healthcare Provider Details

I. General information

NPI: 1821314972
Provider Name (Legal Business Name): KATHERINE SEYBOLT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 TRANSIT RD
WILLIAMSVILLE NY
14221-2820
US

IV. Provider business mailing address

8270 TRANSIT RD
WILLIAMSVILLE NY
14221-2820
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-5613
  • Fax: 716-636-5620
Mailing address:
  • Phone: 716-636-5613
  • Fax: 716-636-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046907
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: