Healthcare Provider Details

I. General information

NPI: 1720324155
Provider Name (Legal Business Name): LAURIE SUZANNE KOFFLER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11607 METROPOLITAN AVE
RICHMOND HILL NY
11418-1018
US

IV. Provider business mailing address

11607 METROPOLITAN AVE
RICHMOND HILL NY
11418-1018
US

V. Phone/Fax

Practice location:
  • Phone: 718-441-2345
  • Fax: 718-441-2424
Mailing address:
  • Phone: 718-441-2345
  • Fax: 718-441-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: