Provider Demographics
NPI:1215253422
Name:PIECHALAK, PAUL (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PIECHALAK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 MCKINLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-2660
Mailing Address - Country:US
Mailing Address - Phone:716-824-8013
Mailing Address - Fax:716-824-2372
Practice Address - Street 1:3740 MCKINLEY PKWY
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-2660
Practice Address - Country:US
Practice Address - Phone:716-824-8013
Practice Address - Fax:716-824-2372
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist