MEDICARE: DR. KELLY ANNE DARLAK PHARM.D, BCPS

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	049791	NY

General Provider Information

NPI Number	:	1801938287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY ANNE DARLAK PHARM.D, BCPS

Provider Business Mailing Address
First Line	:	1499 VANDERBILT AVE
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-1818
Country	:	US
Telephone Number	:	716-957-3692
Fax Number	:

Provider Business Practice Location Address
First Line	:	1499 VANDERBILT AVE
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-1818
Country	:	US
Telephone Number	:	716-319-2357
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/19/2014

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