Provider Demographics
NPI:1346272358
Name:NIAGARA LOCKPORT ENTERPRISES INC
Entity Type:Organization
Organization Name:NIAGARA LOCKPORT ENTERPRISES INC
Other - Org Name:TOPS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-635-5274
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-1027
Mailing Address - Country:US
Mailing Address - Phone:716-635-5276
Mailing Address - Fax:716-635-5992
Practice Address - Street 1:5827 S TRANSIT RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-6317
Practice Address - Country:US
Practice Address - Phone:716-439-4377
Practice Address - Fax:855-331-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0185353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00886219Medicaid
2062376OtherPK
0402000001Medicare NSC