Max Tyler Buscaglia
Individual provider Active NPI Pharmacist · Massena, NY
NPI 1770195448 · NPPES record last updated Nov 28, 2021
Key facts
- NPI
- 1770195448
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 066145 (NY)
- Practice address
- 303 Main St
Massena, NY 13662-1903 - Phone
- (315) 764-0204
- NPI assigned
- Aug 23, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 066145 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current |
Accepting new patients | |
| Walgreen Co | Current |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Locations
303 Main St
Massena, NY 13662
Phone (315) 764-0204
173 Market St
Potsdam, NY 13676
Phone (315) 265-2603
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 066145 | NY | Yes |
Addresses
Primary practice location
303 Main St
Massena, NY 13662-1903
Mailing address
17 Stevens St Apt A2
Canton, NY 13617-1370
Other practice location 1
173 Market St
Potsdam, NY 13676-1221
Phone (315) 265-6192
Other practice location 2
97 E Main St
Canton, NY 13617-1445
Phone (315) 386-8611
Other providers in Massena, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2021. 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.