Provider Demographics
NPI:1750560082
Name:GAVAZZI, ALFRED JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:JOHN
Last Name:GAVAZZI
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 1:125 S TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-4834
Mailing Address - Country:US
Mailing Address - Phone:716-433-2678
Mailing Address - Fax:716-433-3701
Practice Address - Street 1:125 S TRANSIT RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-4834
Practice Address - Country:US
Practice Address - Phone:716-433-2678
Practice Address - Fax:716-433-3701
Is Sole Proprietor?:No
Enumeration Date:2007-11-03
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025886OtherSTATE LICENSE