Healthcare Provider Details

I. General information

NPI: 1942767660
Provider Name (Legal Business Name): KOCHER PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14657 NORTHLINE RD
SOUTHGATE MI
48195-2483
US

IV. Provider business mailing address

14657 NORTHLINE RD
SOUTHGATE MI
48195-2483
US

V. Phone/Fax

Practice location:
  • Phone: 734-720-7480
  • Fax: 734-720-7943
Mailing address:
  • Phone: 734-720-7480
  • Fax: 734-720-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AHMAD ATTALLA
Title or Position: OWNER
Credential: PHARM.D.
Phone: 313-587-2944