Healthcare Provider Details

I. General information

NPI: 1013249390
Provider Name (Legal Business Name): ALLA KOGAN PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

6916 222ND ST
OAKLAND GARDENS NY
11364-2620
US

V. Phone/Fax

Practice location:
  • Phone: 718-486-2787
  • Fax:
Mailing address:
  • Phone: 718-428-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number054115
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number054115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: