Provider Demographics
NPI:1639104839
Name:VETERANS ADMINISTRATION WESTERN NEW YORK HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:VETERANS ADMINISTRATION WESTERN NEW YORK HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:PUDHORODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-862-6334
Mailing Address - Street 1:21 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2853
Mailing Address - Country:US
Mailing Address - Phone:716-667-3967
Mailing Address - Fax:
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-862-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027125282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital