Provider Demographics
NPI:1891027421
Name:KOEPF, AMY LYNN
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:KOEPF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 THREE ROD RD
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-9600
Mailing Address - Country:US
Mailing Address - Phone:716-937-0353
Mailing Address - Fax:
Practice Address - Street 1:12775 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-9569
Practice Address - Country:US
Practice Address - Phone:716-937-6316
Practice Address - Fax:716-505-1467
Is Sole Proprietor?:No
Enumeration Date:2010-02-07
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist