Provider Demographics
NPI:1669508867
Name:KAPPEN, EDWARD J
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:KAPPEN
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 THOMAS CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9726
Mailing Address - Country:US
Mailing Address - Phone:585-223-2982
Mailing Address - Fax:
Practice Address - Street 1:804 GOODMAN ST N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-4640
Practice Address - Country:US
Practice Address - Phone:585-288-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist