Michael Merrick Reilly, RPH
Individual provider Active NPI Pharmacist · Blasdell, NY
NPI 1184743395 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1184743395
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 042099 (NY)
- Practice address
- 3713 S Park Ave
Blasdell, NY 14219-1129 - Phone
- (716) 823-9800
- NPI assigned
- Mar 28, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042099 | NY | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forster'S Pharmacy, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 042099 | NY | Yes |
Addresses
Primary practice location
3713 S Park Ave
Blasdell, NY 14219-1129
Mailing address
5869 Shamrock CT
Hamburg, NY 14075-4075
Phone (716) 648-5465
Other providers in Blasdell, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.