Provider Demographics
NPI:1396865465
Name:MAXON, JOHN W (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MAXON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 N AMERICA DR
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-5315
Mailing Address - Country:US
Mailing Address - Phone:716-677-4805
Mailing Address - Fax:800-317-5595
Practice Address - Street 1:2410 N AMERICA DR
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-5315
Practice Address - Country:US
Practice Address - Phone:716-677-4805
Practice Address - Fax:800-317-5595
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist