Provider Demographics
NPI:1356522098
Name:KUBLITZ, JAN A (RPH)
Entity type:Individual
Prefix:MR
First Name:JAN
Middle Name:A
Last Name:KUBLITZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SHELLRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1389
Mailing Address - Country:US
Mailing Address - Phone:716-636-9867
Mailing Address - Fax:
Practice Address - Street 1:700 THRUWAY PLAZA DRIVE
Practice Address - Street 2:TOPS PAHRMACY
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227
Practice Address - Country:US
Practice Address - Phone:716-929-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist