Provider Demographics
NPI:1639347412
Name:LEGAULT, ROBERT J (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:LEGAULT
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 1:360 KAYMAR DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3016
Mailing Address - Country:US
Mailing Address - Phone:716-691-5426
Mailing Address - Fax:
Practice Address - Street 1:756 E DELAVAN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3042
Practice Address - Country:US
Practice Address - Phone:716-893-0417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist