# BLACK ROCK PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Black Rock Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457917544
- **Authorized official:** BRADLEY JOHN ARTHUR RPH (OWNER)
- **Authorized official phone:** (716) 876-3070

## Contact information

- **Practice address:** 431 TONAWANDA ST, BUFFALO, NY 14207-2625
- **Practice address phone:** (716) 876-3070
- **Practice address fax:** (716) 876-7464
- **Mailing address:** 431 TONAWANDA ST, BUFFALO, NY 14207-2625
- **Mailing address phone:** (716) 876-3070
- **Mailing address fax:** (716) 876-7464

## Taxonomy

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

## Other

- **Enumeration date:** 05/14/2019
- **Last updated:** 05/14/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00591864 | — | NY |