Provider Demographics
NPI:1821142894
Name:MARKS, JEFFREY ARNO (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ARNO
Last Name:MARKS
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 1:9 WEST MAIN ST.
Mailing Address - Street 2:PO BOX 128
Mailing Address - City:FRIENDSHIP
Mailing Address - State:NY
Mailing Address - Zip Code:14739
Mailing Address - Country:US
Mailing Address - Phone:585-973-3496
Mailing Address - Fax:585-973-3631
Practice Address - Street 1:9 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:NY
Practice Address - Zip Code:14739
Practice Address - Country:US
Practice Address - Phone:585-973-3496
Practice Address - Fax:585-973-3631
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01462275Medicaid