# 5775 MAELOU DRIVE OPERATING COMPANY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 5775 MAELOU DRIVE OPERATING COMPANY, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1184058083
- **Legal business name:** 5775 MAELOU DRIVE OPERATING COMPANY, LLC
- **Authorized official:** DR. JEFFREY RUBIN (CO-CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (716) 817-5075

## Contact information

- **Practice address:** 5775 MAELOU DR, HAMBURG, NY 14075-7419
- **Practice address phone:** (716) 648-2820
- **Mailing address:** 500 SENECA ST STE 100, BUFFALO, NY 14204-1963
- **Mailing address phone:** (716) 633-3900
- **Mailing address fax:** (646) 924-0520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 08/27/2013
- **Last updated:** 01/19/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 031934 | NY BOARD OF PHARMACY REGISTRATION | NY |