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General NPI Number Information
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NPI Number | 1972074797
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Entity Type | Organization
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Legal Business Name | ROSWELL PARK PHARMACY CORPORATION
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | ELM & CARLTON STS.
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City | BUFFALO
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State | NY
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Zip | 14263
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Country | US
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Telephone | 716-845-8999
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Fax | 716-845-8996
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Provider Business Mailing Address
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Address Line | ELM & CARLTON STS.
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City | BUFFALO
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State | NY
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Zip | 14263
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Country | US
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Telephone | 716-845-8999
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Fax | 716-845-8996
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, PHARMACY
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Name | DR. ANTHONY FERNANDO
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Credential | PHD, MBA, RPH
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Telephone | 716-845-2903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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