Provider Demographics
NPI:1134330111
Name:BAROUDI, JOAN A (RPH)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:A
Last Name:BAROUDI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HUBBARDSTON PL
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2832
Mailing Address - Country:US
Mailing Address - Phone:716-691-4590
Mailing Address - Fax:
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:D-17 MICHAEL HALL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-829-2368
Practice Address - Fax:716-829-2531
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032345-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist