Provider Demographics
NPI:1396034062
Name:HOFFNAGLE, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HOFFNAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6187 STATE ROUTE 30 # MS 3000
Mailing Address - Street 2:
Mailing Address - City:LAKE CLEAR
Mailing Address - State:NY
Mailing Address - Zip Code:12945-1907
Mailing Address - Country:US
Mailing Address - Phone:678-231-4905
Mailing Address - Fax:
Practice Address - Street 1:6187 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:LAKE CLEAR
Practice Address - State:NY
Practice Address - Zip Code:12945-1907
Practice Address - Country:US
Practice Address - Phone:678-231-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055184-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist