Active NPI
Justin Raymond Roulley, PHARMD
- Pharmacist
- Clarence, NY
National Provider Identifier
1750904868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 066888
- Practice address
- 9217 Main St
Clarence, NY 14031-1931 - Phone
- (716) 634-7901
- Fax
- (716) 634-7907
- NPI assigned
- May 22, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 066888 | NY | Primary |
Addresses
Primary practice location
9217 Main St
Clarence, NY 14031-1931
Mailing address
5040 Meadowbrook Rd
Williamsville, NY 14221-4214
Phone (716) 316-4131
Other practice location 1
1306 Military Rd
Niagara Falls, NY 14304-1775
Phone (716) 298-3504
Other practice location 2
2043 Kensington Ave
Amherst, NY 14226-4722
Phone (716) 839-1906
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 066888 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Eastern Co Inc | Past | Accepting new patients | |
| Walgreen Eastern Co Inc | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
9217 Main St
Clarence, NY 14031
Phone (716) 634-7901
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749168000000",
"number": "1750904868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5040 MEADOWBROOK RD",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142214214",
"telephone_number": "716-316-4131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9217 MAIN ST",
"city": "CLARENCE",
"state": "NY",
"postal_code": "140311931",
"telephone_number": "716-634-7901",
"fax_number": "716-634-7907"
}
],
"practiceLocations": [
{
"address_1": "1306 Military Rd",
"address_purpose": "LOCATION",
"city": "Niagara Falls",
"state": "NY",
"postal_code": "143041775",
"country_code": "US",
"telephone_number": "716-298-3504",
"fax_number": "716-298-5405",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2043 Kensington Ave",
"address_purpose": "LOCATION",
"city": "Amherst",
"state": "NY",
"postal_code": "142264722",
"country_code": "US",
"telephone_number": "716-839-1906",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROULLEY",
"first_name": "JUSTIN",
"middle_name": "RAYMOND",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-05-22",
"last_updated": "2025-06-06",
"certification_date": "2025-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "066888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarence, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.