Provider Demographics
NPI:1821263013
Name:PROKOP, JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PROKOP
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 1:53 GLEN ACRE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2731
Mailing Address - Country:US
Mailing Address - Phone:585-334-7451
Mailing Address - Fax:
Practice Address - Street 1:23 SLAYTON AVE
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1427
Practice Address - Country:US
Practice Address - Phone:585-352-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist