Healthcare Provider Details

I. General information

NPI: 1992186001
Provider Name (Legal Business Name): COKA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 WATKINS STREET
BROOKLYN NY
11212
US

IV. Provider business mailing address

161 WATKINS STREET
BROOKLYN NY
11212
US

V. Phone/Fax

Practice location:
  • Phone: 718-566-6292
  • Fax:
Mailing address:
  • Phone: 718-566-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. MAYA AVIVA COHEN
Title or Position: PIC OWNER
Credential: RPH
Phone: 718-566-6292