Provider Demographics
NPI:1124208848
Name:LEFCO, JUSTIN P (RPH)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:P
Last Name:LEFCO
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 1:135 WINEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4721
Mailing Address - Country:US
Mailing Address - Phone:518-289-5374
Mailing Address - Fax:
Practice Address - Street 1:22 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOOSICK FALLS
Practice Address - State:NY
Practice Address - Zip Code:12090-2002
Practice Address - Country:US
Practice Address - Phone:518-686-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist