=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952205825
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE RAE LIPTAK PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2026
-----------------------------------------------------
Last Update Date | 10/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9888 FELTHAM CT
-----------------------------------------------------
City | CLARENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14031-2077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-861-6634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9888 FELTHAM CT
-----------------------------------------------------
City | CLARENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14031-2077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 070696-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------