Provider Demographics
NPI:1750968236
Name:PHS NFM, LLC
Entity type:Organization
Organization Name:PHS NFM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WACLAWEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:716-998-3468
Mailing Address - Street 1:621 10TH ST STE 172
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1813
Mailing Address - Country:US
Mailing Address - Phone:716-501-8623
Mailing Address - Fax:716-501-5014
Practice Address - Street 1:621 10TH ST STE 172
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1813
Practice Address - Country:US
Practice Address - Phone:716-501-8623
Practice Address - Fax:716-501-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy