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Organization

IVYLEA PHARMACY INC

Active
Other names
IVYLEA PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
CHARLES BARONS DOCTOR OF PHARM (SUPERVISING PHARMACIST)
(716) 873-1444
Entity
Organization

Contact information

Practice address
2446 ELMWOOD AVE, KENMORE, NY 14217-2244
(716) 873-1444
(716) 873-5496
Mailing address
2446 ELMWOOD AVE, KENMORE, NY 14217-2244
(716) 873-1444
(716) 873-5496

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
028936
NY
3336C0004X
Compounding Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03125197
NY
01
2059325
PK
05
3125197
NY
Enumeration date
09/12/2006
Last updated
04/17/2017
About Stedi
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