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General NPI Number Information
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NPI Number | 1548380066
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Entity Type | Individual
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Provider Name | EDWARD JOSEPH DYBALA BSPHARM
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 02/05/2009
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Provider Practice Location Address
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Address Line | S6150 SOUTH PARK AVE
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City | HAMBURG
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State | NY
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Zip | 14075
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Country | US
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Telephone | 716-515-3305
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Fax |
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Provider Business Mailing Address
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Address Line | 3453 HEATHERWOOD DR
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City | HAMBURG
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State | NY
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Zip | 14075-2137
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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 |
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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 | 35150
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License Number State | NY
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