Provider Demographics
NPI:1669570578
Name:STACHNIK, DAVID ROBERT
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROBERT
Last Name:STACHNIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 SEVERN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9144
Mailing Address - Country:US
Mailing Address - Phone:585-259-5240
Mailing Address - Fax:607-569-3250
Practice Address - Street 1:4366 BUFFALO RD.
Practice Address - Street 2:
Practice Address - City:N. CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514
Practice Address - Country:US
Practice Address - Phone:585-594-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist