Provider Demographics
NPI:1205016532
Name:MCENTARFER, MICHAEL WALTER
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WALTER
Last Name:MCENTARFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3795 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1415
Mailing Address - Country:US
Mailing Address - Phone:716-672-6000
Mailing Address - Fax:716-672-6099
Practice Address - Street 1:3795 E MAIN RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1415
Practice Address - Country:US
Practice Address - Phone:716-672-6000
Practice Address - Fax:716-672-6099
Is Sole Proprietor?:No
Enumeration Date:2007-11-03
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist