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General NPI Number Information
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NPI Number | 1902830516
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Entity Type | Organization
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Legal Business Name | TLC HEALTH NETWORK OUTPATIENT PHARMACY
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 845 ROUTES 5 & 20
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City | IRVING
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State | NY
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Zip | 14081
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Country | US
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Telephone | 716-951-7260
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Fax | 716-951-7262
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Provider Business Mailing Address
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Address Line | 845 ROUTES 5 & 20
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City | IRVING
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State | NY
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Zip | 14081
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Country | US
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Telephone | 716-951-7260
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Fax | 716-951-7262
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MR. ERIC STURM
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Credential | R.PH.
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Telephone | 716-951-7261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 025264
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 025264
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 025264
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | 025264
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 025264
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License Number State | NY
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