Provider Demographics
NPI:1972084408
Name:KAPUSCINSKI, ERIC MATTHEW (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MATTHEW
Last Name:KAPUSCINSKI
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 1:1142 WEHRLE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7750
Mailing Address - Country:US
Mailing Address - Phone:716-631-3381
Mailing Address - Fax:
Practice Address - Street 1:1142 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7750
Practice Address - Country:US
Practice Address - Phone:716-631-3381
Practice Address - Fax:716-883-0760
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist