Provider Demographics
NPI:1720324155
Name:KOFFLER, LAURIE SUZANNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:SUZANNE
Last Name:KOFFLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11607 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1018
Mailing Address - Country:US
Mailing Address - Phone:718-441-2345
Mailing Address - Fax:718-441-2424
Practice Address - Street 1:11607 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1018
Practice Address - Country:US
Practice Address - Phone:718-441-2345
Practice Address - Fax:718-441-2424
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist