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General NPI Number Information
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NPI Number | 1699891937
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Entity Type | Individual
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Provider Name | KENNETH JOSEPH MOFFA RPH
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 81 MAIN STREET WHITES PHARMACY
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City | EAST HAMPTON
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State | NY
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Zip | 11937
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Country | US
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Telephone | 631-324-0082
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Fax | 631-324-0338
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Provider Business Mailing Address
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Address Line | 4 CHIVAS COURT
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-3740
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Country | US
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Telephone | 631-283-3943
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24002-1
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License Number State | NY
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