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General NPI Number Information
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NPI Number | 1063690253
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Entity Type | Individual
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Provider Name | MISS JACQUELINE ANN CANSDALE
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Gender | Female
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Dates
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Enumeration Date | 02/10/2008
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Last Update Date | 02/10/2008
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Provider Practice Location Address
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Address Line | 4920 TRANSIT RD T2191
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City | DEPEW
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State | NY
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Zip | 14043-4625
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Country | US
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Telephone | 716-608-2021
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Fax | 716-608-2021
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Provider Business Mailing Address
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Address Line | 28 AMERICO CT
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City | LANCASTER
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State | NY
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Zip | 14086-3424
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Country | US
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Telephone | 716-683-4120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 044928
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License Number State | NY
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