Provider Demographics
NPI:1366622458
Name:BANAS, DONALD MICHAEL
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:MICHAEL
Last Name:BANAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-1461
Mailing Address - Country:US
Mailing Address - Phone:716-892-7575
Mailing Address - Fax:716-892-3342
Practice Address - Street 1:1018 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1461
Practice Address - Country:US
Practice Address - Phone:716-892-7575
Practice Address - Fax:716-892-3342
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist