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General NPI Number Information
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NPI Number | 1821270117
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Entity Type | Individual
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Provider Name | JASON ALAN FOLCK
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Gender | Male
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 1640 HOPKINS RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-1752
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Country | US
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Telephone | 716-568-0075
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Fax |
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Provider Business Mailing Address
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Address Line | 8933 CONNEMARA LN
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City | CLARENCE CENTER
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State | NY
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Zip | 14032-9513
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Country | US
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Telephone | 716-741-8970
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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 | 044661
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License Number State | NY
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