Provider Demographics
NPI:1861041386
Name:JERZ, KATHRYN SARAH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:SARAH
Last Name:JERZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-8835
Mailing Address - Country:US
Mailing Address - Phone:716-946-7810
Mailing Address - Fax:
Practice Address - Street 1:355 RIVERWALK PKWY
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-5837
Practice Address - Country:US
Practice Address - Phone:716-248-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI065431-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist