Provider Demographics
NPI:1134348386
Name:KALEIDA HEALTH LTC PHARMACY
Entity type:Organization
Organization Name:KALEIDA HEALTH LTC PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:KALEIDA HEALTH VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-690-2004
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT # 440
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:445 TREMONT ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6150
Practice Address - Country:US
Practice Address - Phone:716-690-2233
Practice Address - Fax:716-690-2582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0253803336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025380OtherNY PHARMACY REGISTRATION
NY3356462OtherNABP (NCPDP)
NY00354247Medicaid
NYAD0510746OtherDEA NUMBER