Provider Demographics
NPI:1023042553
Name:DUSHAW, JERROLD WILLIAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERROLD
Middle Name:WILLIAM
Last Name:DUSHAW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:5401 OLD LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9751
Mailing Address - Country:US
Mailing Address - Phone:716-627-3543
Mailing Address - Fax:716-862-6348
Practice Address - Street 1:3495 BAILEY AVENUE
Practice Address - Street 2:VA WESTERN NEW YORK
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1199
Practice Address - Country:US
Practice Address - Phone:716-834-9200
Practice Address - Fax:716-862-6348
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY044167-11835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy