Provider Demographics
NPI:1841472701
Name:KIRKBY, JEFFREY (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:KIRKBY
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 1:905 COFFEEN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1816
Mailing Address - Country:US
Mailing Address - Phone:315-788-9366
Mailing Address - Fax:
Practice Address - Street 1:905 COFFEEN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1816
Practice Address - Country:US
Practice Address - Phone:315-788-9366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI040888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist