Provider Demographics
NPI:1801100482
Name:COFIE, CYRIL GEORGE
Entity type:Individual
Prefix:MR
First Name:CYRIL
Middle Name:GEORGE
Last Name:COFIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 TAILWIND CT APT 105E
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8862
Mailing Address - Country:US
Mailing Address - Phone:207-689-3758
Mailing Address - Fax:
Practice Address - Street 1:430 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5430
Practice Address - Country:US
Practice Address - Phone:207-783-2013
Practice Address - Fax:207-783-3085
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist