# KALEIDA HEALTH LTC PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DeGraff Memorial Hospital
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134348386
- **Authorized official:** TAMARA OWEN (KALEIDA HEALTH VICE PRESIDENT)
- **Authorized official phone:** (716) 690-2004

## Contact information

- **Practice address:** 445 TREMONT ST, NORTH TONAWANDA, NY 14120-6150
- **Practice address phone:** (716) 690-2233
- **Practice address fax:** (716) 690-2582
- **Mailing address:** PO BOX 8000, DEPT \# 440, BUFFALO, NY 14267-0002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 025380 | NY | Yes |

## Other

- **Enumeration date:** 04/25/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00354247 | — | NY |
| 01 | — | 025380 | NY PHARMACY REGISTRATION | NY |
| 01 | — | 3356462 | NABP (NCPDP) | NY |