Provider Demographics
NPI:1326222381
Name:BOOKHOUT, JEFFREY LINN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LINN
Last Name:BOOKHOUT
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 1:23 TANNERY CIR
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053-9700
Mailing Address - Country:US
Mailing Address - Phone:607-844-3653
Mailing Address - Fax:
Practice Address - Street 1:13-15 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053-9700
Practice Address - Country:US
Practice Address - Phone:607-844-3151
Practice Address - Fax:607-844-3043
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01105788Medicaid