=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619249448
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANIELA CARDINAL PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2012
-----------------------------------------------------
Last Update Date | 09/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3085 S PARK AVE
-----------------------------------------------------
City | LACKAWANNA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14218-3109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-824-6263
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 61 CENTER DR
-----------------------------------------------------
City | DEPEW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14043-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-901-6619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 056128
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------