Provider Demographics
NPI:1417289695
Name:KIRKER, JOHN EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:KIRKER
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 1:1980 ALPHA CIR
Mailing Address - Street 2:3D
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-9550
Mailing Address - Country:US
Mailing Address - Phone:607-849-6156
Mailing Address - Fax:607-849-6111
Practice Address - Street 1:1980 ALPHA CIR
Practice Address - Street 2:3D
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-9550
Practice Address - Country:US
Practice Address - Phone:607-849-6156
Practice Address - Fax:607-849-6111
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist