Provider Demographics
NPI:1417230194
Name:ZASUCHA, ZACHARY JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JOHN
Last Name:ZASUCHA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14174-0205
Mailing Address - Country:US
Mailing Address - Phone:716-828-0194
Mailing Address - Fax:716-825-4085
Practice Address - Street 1:2175 S PARK AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2231
Practice Address - Country:US
Practice Address - Phone:716-828-0194
Practice Address - Fax:716-825-4085
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist