Provider Demographics
NPI:1992716542
Name:LAKEWOOD HEALTH CARE CNTR PHARMACY
Entity type:Organization
Organization Name:LAKEWOOD HEALTH CARE CNTR PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-631-3381
Mailing Address - Street 1:1142 WEHRLE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5775 MAELOU DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-7419
Practice Address - Country:US
Practice Address - Phone:716-648-2820
Practice Address - Fax:716-631-8732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEWOOD HEALTH CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-10
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0250913336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3323590OtherOTHER ID NUMBER-COMMERCIAL NUMBER