Provider Demographics
NPI:1194486548
Name:VILLAGE PHARMACY OF LOCKPORT, INC.
Entity type:Organization
Organization Name:VILLAGE PHARMACY OF LOCKPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDALAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-796-5668
Mailing Address - Street 1:6478 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1015
Mailing Address - Country:US
Mailing Address - Phone:716-302-3434
Mailing Address - Fax:716-727-3302
Practice Address - Street 1:6478 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1015
Practice Address - Country:US
Practice Address - Phone:716-302-3434
Practice Address - Fax:716-727-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy