Provider Demographics
NPI:1649602889
Name:HATHAWAY, NATALIE ROSE (PHARMD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ROSE
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:ROSE
Other - Last Name:EDBAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:511 FARBER LAKES DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8272
Mailing Address - Country:US
Mailing Address - Phone:716-635-7877
Mailing Address - Fax:
Practice Address - Street 1:511 FARBER LAKES DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8272
Practice Address - Country:US
Practice Address - Phone:716-635-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058247-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist