Provider Demographics
NPI:1235301987
Name:VARNUM, NATHANIEL WILLIAM (RPH, MBA-HCM)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:WILLIAM
Last Name:VARNUM
Suffix:
Gender:M
Credentials:RPH, MBA-HCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3706
Mailing Address - Country:US
Mailing Address - Phone:716-656-0173
Mailing Address - Fax:716-656-0535
Practice Address - Street 1:1180 FRENCH RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-3706
Practice Address - Country:US
Practice Address - Phone:716-656-0173
Practice Address - Fax:716-656-0535
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist