=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144181850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKVIEWRX DELAWARE 2 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2025
-----------------------------------------------------
Last Update Date | 11/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 N SHIPLEY ST UNIT 2
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19801-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-658-9196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3920 MAIN ST STE 100
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14226-3350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | JUSTIN WACLAWEK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-876-2323
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------