Provider Demographics
NPI:1659650190
Name:CARUSO, JONATHAN NICHOLAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:NICHOLAS
Last Name:CARUSO
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 1:5498 HALLMARK LN
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-6257
Mailing Address - Country:US
Mailing Address - Phone:716-438-9050
Mailing Address - Fax:
Practice Address - Street 1:1791 S PARK AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1411
Practice Address - Country:US
Practice Address - Phone:716-823-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist