Healthcare Provider Details

I. General information

NPI: 1932554136
Provider Name (Legal Business Name): JOHN LOWELL KOFORD JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 EDGEWOOD AVE
BUFFALO NY
14223-2526
US

IV. Provider business mailing address

288 EDGEWOOD AVE
BUFFALO NY
14223-2526
US

V. Phone/Fax

Practice location:
  • Phone: 716-835-0936
  • Fax:
Mailing address:
  • Phone: 716-835-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041256
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: