NPIMap

Organization Active NPI

Roswell Park Cancer Institute

  • Pharmacy
  • Williamsville, NY
National Provider Identifier
1871379586
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
ROSWELL PARK CANCER INSTITUTE
Practice address
203 Park Club Lane
C/O Pharmacy
Williamsville, NY 14221
Phone
(716) 845-2946
Fax
(716) 845-2955
NPI assigned
Sep 7, 2023
Last updated
Jul 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Candace Johnson, PHD
Title
President and Ceo
Phone
(716) 845-5772

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU Primary

Addresses

Primary practice location

203 Park Club Lane
C/O Pharmacy
Williamsville, NY 14221

Mailing address

Elm and Carlton St
Buffalo, NY 14263-0001
Phone (716) 845-5785

Other identifiers 1

IdentifierTypeStateIssuer
00354518MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231120001455 NY Part B Supplier - Pharmacy 3577475110 Practice locations: Williamsville, NY

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D1055768Roswell Park Cancer Institute Amherst203 Park Club Lane, Williamsville, NY 14221ComplianceMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Roswell Park Cancer Ins4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

100 College Pkwy
Ste 290
Williamsville, NY 14221
Phone (716) 845-2900

203 Park Club Ln
Williamsville, NY 14221
Phone (716) 845-7779

203 Park Club Ln
Ste Z200
Williamsville, NY 14221
Phone (716) 845-8936

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Roswell Park Cancer InstituteBuffalo, NY, CCN 330354 Hospital Operational/Managerial Control Jan 1, 1999

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 553

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 553

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784073600000",
    "number": "1871379586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ELM AND CARLTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142630001",
            "telephone_number": "716-845-5785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 PARK CLUB LANE",
            "address_2": "C/O PHARMACY",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "14221",
            "telephone_number": "716-845-2946",
            "fax_number": "716-845-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSWELL PARK CANCER INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-07",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "716-845-5772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00354518",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.