Provider Demographics
NPI:1477144152
Name:POLIFKO, KEVIN (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:POLIFKO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1121
Mailing Address - Country:US
Mailing Address - Phone:717-637-6388
Mailing Address - Fax:
Practice Address - Street 1:1000 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1121
Practice Address - Country:US
Practice Address - Phone:717-637-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist