Provider Demographics
NPI:1699984971
Name:WATTENGEL, JAMES MARTIN (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MARTIN
Last Name:WATTENGEL
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 1:72 WILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2761
Mailing Address - Country:US
Mailing Address - Phone:716-873-6009
Mailing Address - Fax:
Practice Address - Street 1:2887 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-3038
Practice Address - Country:US
Practice Address - Phone:716-892-8115
Practice Address - Fax:716-892-6027
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist