Provider Demographics
NPI:1174839708
Name:KAVI, RICHARD OFOE
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:OFOE
Last Name:KAVI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351
Mailing Address - Country:US
Mailing Address - Phone:207-622-6598
Mailing Address - Fax:
Practice Address - Street 1:943 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351
Practice Address - Country:US
Practice Address - Phone:207-622-6598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist