Provider Demographics
NPI:1871585331
Name:HOFFMAN, FRED (RPH)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:HOFFMAN
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 1:19718 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2127
Mailing Address - Country:US
Mailing Address - Phone:718-464-2400
Mailing Address - Fax:718-736-0600
Practice Address - Street 1:19718 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2127
Practice Address - Country:US
Practice Address - Phone:718-464-2400
Practice Address - Fax:718-736-0600
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037860-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist