Provider Demographics
NPI:1376665778
Name:WISNIEWSKI, RICHARD B (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:WISNIEWSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2705
Mailing Address - Country:US
Mailing Address - Phone:716-862-0475
Mailing Address - Fax:716-862-0917
Practice Address - Street 1:1701 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2705
Practice Address - Country:US
Practice Address - Phone:716-862-0475
Practice Address - Fax:716-862-0917
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist