Healthcare Provider Details

I. General information

NPI: 1073873063
Provider Name (Legal Business Name): RONALD B KOEHLER RPH, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W FRYE RD
CHANDLER AZ
85224-4950
US

IV. Provider business mailing address

2700 W FRYE RD
CHANDLER AZ
85224-4950
US

V. Phone/Fax

Practice location:
  • Phone: 888-694-7287
  • Fax:
Mailing address:
  • Phone: 888-694-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberMOP022003750
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012940
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS016837
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: