Provider Demographics
NPI:1811219959
Name:BARBACK, WOLIS (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:WOLIS
Middle Name:
Last Name:BARBACK
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 LYNN LEA ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3147
Mailing Address - Country:US
Mailing Address - Phone:716-633-1982
Mailing Address - Fax:
Practice Address - Street 1:425 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1887
Practice Address - Country:US
Practice Address - Phone:716-852-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020768-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist