Provider Demographics
NPI:1134718828
Name:JEFKO, LOUIS A (RPH)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:A
Last Name:JEFKO
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 1:297 MARTELLAGO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34275-6710
Mailing Address - Country:US
Mailing Address - Phone:941-244-2720
Mailing Address - Fax:
Practice Address - Street 1:5350 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6401
Practice Address - Country:US
Practice Address - Phone:941-379-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS29340OtherBOARD OF PHARMACY