Provider Demographics
NPI:1730403577
Name:HOFFMAN BEECHKO, JOANNE LESLIE (RPH)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:LESLIE
Last Name:HOFFMAN BEECHKO
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 1:1963 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-6216
Mailing Address - Country:US
Mailing Address - Phone:631-462-2233
Mailing Address - Fax:631-462-2325
Practice Address - Street 1:1963 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-6216
Practice Address - Country:US
Practice Address - Phone:631-462-2233
Practice Address - Fax:631-462-2325
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01206899Medicaid