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General NPI Number Information
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NPI Number | 1275758096
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Entity Type | Individual
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Provider Name | PETER K ILLIG RPH PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 445 BROAD ST
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City | SALAMANCA
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State | NY
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Zip | 14779-1424
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Country | US
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Telephone | 716-945-2140
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Fax | 716-945-0857
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Provider Business Mailing Address
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Address Line | 23 MEMORIAL DR
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City | CATTARAUGUS
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State | NY
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Zip | 14719-1234
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Country | US
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Telephone | 716-257-3723
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Fax | 716-945-0857
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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 | 033353-1
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License Number State | NY
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