Provider Demographics
NPI:1114932704
Name:NIAGARA APOTHECARY INC.
Entity Type:Organization
Organization Name:NIAGARA APOTHECARY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LATKO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-297-3530
Mailing Address - Street 1:8745 NIAGARA FALLS BLVD.
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1933
Mailing Address - Country:US
Mailing Address - Phone:716-297-3530
Mailing Address - Fax:716-297-3950
Practice Address - Street 1:8745 NIAGARA FALLS BLVD.
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1933
Practice Address - Country:US
Practice Address - Phone:716-297-3530
Practice Address - Fax:716-297-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0232493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02094273Medicaid
3322601OtherNCPCP
BN5345574OtherDEA
NY02094273Medicaid