Provider Demographics
NPI:1023394038
Name:KAUFMAN, ALAN MARTIN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MARTIN
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 WHISKEY RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7337
Mailing Address - Country:US
Mailing Address - Phone:803-642-5371
Mailing Address - Fax:803-642-5417
Practice Address - Street 1:1795 WHISKEY RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7337
Practice Address - Country:US
Practice Address - Phone:803-642-5371
Practice Address - Fax:803-642-5417
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC10919183500000X
NC17085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist