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General NPI Number Information
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NPI Number | 1104344092
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Entity Type | Individual
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Provider Name | MALLORI ANNE OCHTERSKI
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Gender | Female
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4060 N BUFFALO ST
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2444
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Country | US
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Telephone | 716-662-4401
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Fax |
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Provider Business Mailing Address
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Address Line | 110 WOODSIDE DR
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City | ELMA
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State | NY
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Zip | 14059-9202
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Country | US
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Telephone | 716-341-3067
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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 | 063379
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License Number State | NY
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