Provider Demographics
NPI:1093015125
Name:LEFOER, PHILIP MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:MICHAEL
Last Name:LEFOER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 STATE ROUTE 534
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444
Mailing Address - Country:US
Mailing Address - Phone:330-872-1276
Mailing Address - Fax:330-872-1285
Practice Address - Street 1:2300 STATE ROUTE 534
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444
Practice Address - Country:US
Practice Address - Phone:330-872-1276
Practice Address - Fax:330-872-1285
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0991502Medicaid
OH0459230043Medicare UPIN