MEDICARE: MRS. MARY L PAZDERSKI RPH

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
1	183500000X	Pharmacist	042349-1	NY

General Provider Information

NPI Number	:	1356551436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY L PAZDERSKI RPH

Provider Business Mailing Address
First Line	:	139 CARLA LN
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-4467
Country	:	US
Telephone Number	:	716-677-4694
Fax Number	:	716-675-7777

Provider Business Practice Location Address
First Line	:	40 GARDENVILLE PKWY W
Second Line	:	SUITE 104
City	:	WEST SENECA
State	:	NY
Zip	:	14224-1387
Country	:	US
Telephone Number	:	716-675-3784
Fax Number	:	716-675-7777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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