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NPI Code Detail

MEDICARE: BUFFALO PRESCRIPTION SHOP, INC

MEDICARE: BUFFALO PRESCRIPTION SHOP, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336L0003XLong Term Care Pharmacy
33336C0003XCommunity/Retail Pharmacy5200112WY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12111130OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003995788
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUFFALO PRESCRIPTION SHOP, INC
Provider Business Mailing Address
First Line : 431 FORT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1805
Country : US
Telephone Number : 307-684-7003
Fax Number : 307-684-7348
Provider Business Practice Location Address
First Line : 431 FORT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1805
Country : US
Telephone Number : 307-684-7003
Fax Number : 307-684-7348
Authorized Official
Title or Position : OWNER/PHARMACIST-IN-CHARGE
Name : TOM ALLEN MAERTENS
Credential : RPH.
Telephone Number : 307-684-7003
Provider Enumeration Date : 11/03/2006
Last Update Date : 10/22/2018

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1790396125 — DR. JUSTIN WATERSON PHARMD
Practice Location Address:
431 FORT ST
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82834-1805
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1043195068 — LYDIA FRITSCHE PHARMD
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1376609313 — DR. DANILO B SALDANA M.D.
Practice Location Address:
993 DELAWARE AVE
BUFFALO, NY
14209-1805
Practice Phone: 716-882-1160
Practice Fax: 716-882-0120

Directions to “BUFFALO PRESCRIPTION SHOP, INC ” Practice Location

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