Provider Demographics
NPI:1619375995
Name:KOFFI, ADJE DABY
Entity Type:Individual
Prefix:MR
First Name:ADJE
Middle Name:DABY
Last Name:KOFFI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRISTLECONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731
Mailing Address - Country:US
Mailing Address - Phone:215-459-8390
Mailing Address - Fax:
Practice Address - Street 1:671 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:862-237-7601
Practice Address - Fax:862-237-7603
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03075400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist