Provider Demographics
NPI:1073030557
Name:KAUFFMAN, JEREMY RAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:RAY
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56677 COUNTY ROAD 43
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9241
Mailing Address - Country:US
Mailing Address - Phone:574-215-4994
Mailing Address - Fax:
Practice Address - Street 1:4522 ELKHART RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5822
Practice Address - Country:US
Practice Address - Phone:574-875-3010
Practice Address - Fax:574-875-3065
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027182A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy