Healthcare Provider Details

I. General information

NPI: 1144633850
Provider Name (Legal Business Name): GINA KOCHIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1476 ROUTE 9
CLIFTON PARK NY
12065-6524
US

IV. Provider business mailing address

1476 ROUTE 9
CLIFTON PARK NY
12065-6524
US

V. Phone/Fax

Practice location:
  • Phone: 518-373-4950
  • Fax: 518-373-4956
Mailing address:
  • Phone: 518-373-4950
  • Fax: 518-373-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58370
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH027553
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: