Organization
GENESEE VALLEY GROUP HEALTH ASSOCIATION
Active
Other names
Lifetime Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CYNTHIA AMBRES MD,MS (PRESIDENT)
(716) 857-6191
Entity
Organization
Contact information
Practice address
2075 SHERIDAN DR, PHARMACY, BUFFALO, NY 14223-1432
(716) 847-1850
(716) 879-3280
Mailing address
2075 SHERIDAN DR, PHARMACY, BUFFALO, NY 14223-1432
(716) 847-1850
(716) 879-3280
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
027327
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02619212
—
NY
01
—
027327
NYS LICENSE #
NY
01
—
3374686
NCPDP
NY
Enumeration date
09/25/2006
Last updated
08/22/2020
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