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General NPI Number Information
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NPI Number | 1417080011
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Entity Type | Individual
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Provider Name | IAN ADAM LEBERMAN RPH
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 09/05/2008
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Provider Practice Location Address
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Address Line | 4777 TRANSIT RD
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City | DEPEW
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State | NY
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Zip | 14043-4772
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Country | US
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Telephone | 716-515-3290
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Fax | 716-515-3294
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Provider Business Mailing Address
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Address Line | 6913 KIMBERLY DR
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City | LOCKPORT
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State | NY
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Zip | 14094-9094
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Country | US
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Telephone | 716-799-2899
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Fax | 716-515-3294
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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 | 049185
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License Number State | NY
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