Provider Demographics
NPI:1164565222
Name:MACLEODS PHARMACY
Entity Type:Organization
Organization Name:MACLEODS PHARMACY
Other - Org Name:MACLEODS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDZIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-283-8704
Mailing Address - Street 1:8672 BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4365
Mailing Address - Country:US
Mailing Address - Phone:716-283-8704
Mailing Address - Fax:716-283-9521
Practice Address - Street 1:8672 BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4365
Practice Address - Country:US
Practice Address - Phone:716-283-8704
Practice Address - Fax:716-283-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336I0012X
NY0116893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00612717Medicaid
2062057OtherPK
NY00612717Medicaid