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General NPI Number Information
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NPI Number | 1134348386
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Entity Type | Organization
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Legal Business Name | KALEIDA HEALTH LTC PHARMACY
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 445 TREMONT ST
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-6150
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Country | US
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Telephone | 716-690-2233
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Fax | 716-690-2582
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Provider Business Mailing Address
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Address Line | PO BOX 8000 DEPT # 440
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City | BUFFALO
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State | NY
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Zip | 14267-0002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | KALEIDA HEALTH VICE PRESIDENT
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Name | TAMARA OWEN
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Credential |
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Telephone | 716-690-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 025380
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License Number State | NY
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