Provider Demographics
NPI:1407386873
Name:CATHOLIC HEALTH SYSTEM INFUSION PHARMACY INC
Entity Type:Organization
Organization Name:CATHOLIC HEALTH SYSTEM INFUSION PHARMACY INC
Other - Org Name:CATHOLIC HEALTH RX AT SISTERS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:716-359-3121
Mailing Address - Street 1:144 GENESEE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1560
Mailing Address - Country:US
Mailing Address - Phone:716-359-3121
Mailing Address - Fax:
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2648
Practice Address - Country:US
Practice Address - Phone:716-359-3121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH SYSTEM INFUSION PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy