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
—
—
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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