Provider Demographics
NPI:1194114488
Name:NIEHOFF, KEVIN CONNOR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CONNOR
Last Name:NIEHOFF
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19950 W COUNTRY CLUB DR FL 7
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4601
Mailing Address - Country:US
Mailing Address - Phone:305-662-8515
Mailing Address - Fax:
Practice Address - Street 1:19950 W COUNTRY CLUB DR FL 7
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4601
Practice Address - Country:US
Practice Address - Phone:305-662-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17561-40183500000X
PARP453456183500000X
IL051303855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051303855OtherILLINOIS BOARD OF PHARMACY
WI17561-40OtherWISCONSIN BOARD OF PHARMACY
PARP453456OtherPENNSYLVANIA BOARD OF PHARMACY