Provider Demographics
NPI:1851505234
Name:PROCTOR, GAIL BLACK (RPH)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:BLACK
Last Name:PROCTOR
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 1:7205 TRICIA LN
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:NY
Mailing Address - Zip Code:14025-9641
Mailing Address - Country:US
Mailing Address - Phone:716-941-5188
Mailing Address - Fax:
Practice Address - Street 1:400 FOREST AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1207
Practice Address - Country:US
Practice Address - Phone:716-816-2531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist