Provider Demographics
NPI:1003936089
Name:WIZNER, PETER (RPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:WIZNER
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 1:1001 HERTEL AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2614
Mailing Address - Country:US
Mailing Address - Phone:716-875-5272
Mailing Address - Fax:716-875-8867
Practice Address - Street 1:1001 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2614
Practice Address - Country:US
Practice Address - Phone:716-875-5272
Practice Address - Fax:716-875-8867
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist