MEDICARE: MR. ROBERT J. LEGAULT 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	032594	NY

General Provider Information

NPI Number	:	1639347412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT J. LEGAULT RPH

Provider Business Mailing Address
First Line	:	360 KAYMAR DR
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14228-3016
Country	:	US
Telephone Number	:	716-691-5426
Fax Number	:

Provider Business Practice Location Address
First Line	:	756 E DELAVAN AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-3042
Country	:	US
Telephone Number	:	716-893-0417
Fax Number	:

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

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	11/12/2012

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