Provider Demographics
NPI:1154731016
Name:RELIANT PHARMACY CORP
Entity type:Organization
Organization Name:RELIANT PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LANDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-817-5111
Mailing Address - Street 1:3801 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1907
Mailing Address - Country:US
Mailing Address - Phone:716-817-5111
Mailing Address - Fax:716-634-3435
Practice Address - Street 1:3807 HARLEM RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1907
Practice Address - Country:US
Practice Address - Phone:716-817-5111
Practice Address - Fax:716-634-3435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANT PHARMACY CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-30
Last Update Date:2024-04-26
Deactivation Date:2019-08-16
Deactivation Code:
Reactivation Date:2019-09-25
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
NY0327933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04098624Medicaid
1107980002Medicare UPIN