Provider Demographics
NPI:1043314636
Name:COLFER, RICHARD A (BS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:COLFER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BATAVIA HGTS CIR
Mailing Address - Street 2:P.O. BOX 294
Mailing Address - City:MARGARETVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12455-0294
Mailing Address - Country:US
Mailing Address - Phone:845-586-3046
Mailing Address - Fax:845-586-1470
Practice Address - Street 1:778 MAIN STEET
Practice Address - Street 2:
Practice Address - City:MARGARETVILLE
Practice Address - State:NY
Practice Address - Zip Code:12455
Practice Address - Country:US
Practice Address - Phone:845-586-2955
Practice Address - Fax:845-586-3140
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist