Provider Demographics
NPI:1427372143
Name:PIETRUSZEWSKI, MARTIN E (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:E
Last Name:PIETRUSZEWSKI
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 1:2818 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2704
Mailing Address - Country:US
Mailing Address - Phone:716-874-6360
Mailing Address - Fax:716-874-6369
Practice Address - Street 1:2818 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2704
Practice Address - Country:US
Practice Address - Phone:716-874-6360
Practice Address - Fax:716-874-6369
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY035548OtherSTATE LICENSE