Provider Demographics
NPI:1801942115
Name:MANUSZEWSKI, MICHAEL A (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MANUSZEWSKI
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 1:116 PLEASANT TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-3200
Mailing Address - Country:US
Mailing Address - Phone:716-773-9105
Mailing Address - Fax:716-876-3070
Practice Address - Street 1:431 TONAWANDA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-2625
Practice Address - Country:US
Practice Address - Phone:716-876-3070
Practice Address - Fax:716-876-3070
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038139OtherLISCENSE NUMBER