Healthcare Provider Details

I. General information

NPI: 1417136847
Provider Name (Legal Business Name): EDWARD J. LOEFFLER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 FOREST AVE
GLEN COVE NY
11542-2028
US

IV. Provider business mailing address

3 BRIARWOOD DR
GLEN COVE NY
11542-1601
US

V. Phone/Fax

Practice location:
  • Phone: 516-759-1201
  • Fax:
Mailing address:
  • Phone: 516-671-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029926
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: