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Organization
BLACK ROCK PHARMACY INC
Active
Organization
BLACK ROCK PHARMACY INC
Active
Other names
Black Rock Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY JOHN ARTHUR RPH (OWNER)
(716) 876-3070
Entity
Organization
Contact information
Practice address
431 TONAWANDA ST, BUFFALO, NY 14207-2625
(716) 876-3070
(716) 876-7464
Mailing address
431 TONAWANDA ST, BUFFALO, NY 14207-2625
(716) 876-3070
(716) 876-7464
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00591864
—
NY
Enumeration date
05/14/2019
Last updated
05/14/2019
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