Provider Demographics
NPI:1164609327
Name:LOFARO, JOSEPH ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:LOFARO
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 1:3119 CORLEAR DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8923
Mailing Address - Country:US
Mailing Address - Phone:315-635-3368
Mailing Address - Fax:
Practice Address - Street 1:1200 STATE FAIR BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-1070
Practice Address - Country:US
Practice Address - Phone:315-461-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist