Provider Demographics
NPI:1528380946
Name:WIELGOSZ, MARY A (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:WIELGOSZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WEHRLE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7039
Mailing Address - Country:US
Mailing Address - Phone:716-630-8200
Mailing Address - Fax:716-630-8456
Practice Address - Street 1:2100 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7039
Practice Address - Country:US
Practice Address - Phone:716-630-8200
Practice Address - Fax:716-630-8456
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist