Provider Demographics
NPI:1811223589
Name:WAITE, REBECCA (PHARMD, BCPP)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:WAITE
Suffix:
Gender:F
Credentials:PHARMD, BCPP
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:DASILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:425 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-2209
Mailing Address - Country:US
Mailing Address - Phone:716-848-2055
Mailing Address - Fax:
Practice Address - Street 1:425 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2209
Practice Address - Country:US
Practice Address - Phone:716-848-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054116183500000X, 1835P0018X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist