Provider Demographics
NPI:1457861619
Name:EOFF, KURTIS RYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:RYAN
Last Name:EOFF
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 1:17534 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-4221
Mailing Address - Country:US
Mailing Address - Phone:734-250-3364
Mailing Address - Fax:
Practice Address - Street 1:25050 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-4398
Practice Address - Country:US
Practice Address - Phone:734-675-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist