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General NPI Number Information
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NPI Number | 1043762875
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Entity Type | Organization
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Legal Business Name | ERIE CANAL LLC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 60 FINN RD STE B
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City | HENRIETTA
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State | NY
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Zip | 14467-9393
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Country | US
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Telephone | 585-486-4807
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Fax | 585-444-9224
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Provider Business Mailing Address
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Address Line | 60 FINN ROAD SUITE B
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City | HENRIETTA
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State | NY
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Zip | 14467
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Country | US
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Telephone | 585-486-4807
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Fax | 585-444-9224
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Authorized Official
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Title or Position | PHARMACY MANAGER/OWNER
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Name | MR. KHALID HABIB
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Credential | RPH
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Telephone | 585-486-4807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 034950
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License Number State | NY
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