Provider Demographics
NPI:1871885798
Name:ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO NY LLC
Entity type:Organization
Organization Name:ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO NY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, REIMBURSEMENT REVENUE CYCLE MG
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KONAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-662-6633
Mailing Address - Street 1:13410 EASTPOINT CENTRE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4160
Mailing Address - Country:US
Mailing Address - Phone:877-662-6633
Mailing Address - Fax:502-849-0643
Practice Address - Street 1:140 JOHN JAMES AUDUBON PKWY STE 101
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1183
Practice Address - Country:US
Practice Address - Phone:877-662-6633
Practice Address - Fax:877-662-6355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SINA DRUG CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-11
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
NY0307173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6525440001Medicare NSC