Provider Demographics
NPI:1366487894
Name:BUFFALO CLINICAL SERVICES INC
Entity type:Organization
Organization Name:BUFFALO CLINICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-675-4133
Mailing Address - Street 1:1769 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4624
Mailing Address - Country:US
Mailing Address - Phone:716-675-4133
Mailing Address - Fax:716-675-1314
Practice Address - Street 1:1769 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4624
Practice Address - Country:US
Practice Address - Phone:716-675-4133
Practice Address - Fax:716-675-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0200263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065524OtherPK
NY01213941Medicaid
0426530001Medicare NSC