Provider Demographics
NPI:1679587554
Name:JAROSZ, KENNETH M SR (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:M
Last Name:JAROSZ
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SCHWARTZ RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9605
Mailing Address - Country:US
Mailing Address - Phone:716-681-6255
Mailing Address - Fax:
Practice Address - Street 1:4155 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1240
Practice Address - Country:US
Practice Address - Phone:585-344-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist