Organization
GENESEE VALLEY GROUP HEALTH ASSOC
Active
Other names
LIFETIME HEALTH MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN URBANSKI RPH (MANAGER, PHARMACY SERVICES)
(716) 689-3420
Entity
Organization
Contact information
Practice address
899 MAIN ST, BUFFALO, NY 14203-1109
(716) 885-2833
(716) 422-2808
Mailing address
1185 SWEET HOME RD, AMHERST, NY 14226-1018
(716) 689-3420
(716) 689-3472
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
027323
NY
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
PH29885
FL
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02619501
—
NY
01
—
2065029
PK
—
Enumeration date
07/22/2006
Last updated
08/31/2016
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