Provider Demographics
NPI:1790941037
Name:AGONAFER, GIRMA (RPH)
Entity Type:Individual
Prefix:MR
First Name:GIRMA
Middle Name:
Last Name:AGONAFER
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 1:2055 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3518
Mailing Address - Country:US
Mailing Address - Phone:716-691-0738
Mailing Address - Fax:716-691-1030
Practice Address - Street 1:2055 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-3518
Practice Address - Country:US
Practice Address - Phone:716-691-0738
Practice Address - Fax:716-691-1030
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist