Healthcare Provider Details

I. General information

NPI: 1114166303
Provider Name (Legal Business Name): DR. KOJO A SWANZIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KOJO A SWANZIE PHARMD

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S LONG BEACH AVE
FREEPORT NY
11520-3441
US

IV. Provider business mailing address

1287 WOODSIDE AVE
NORTH BALDWIN NY
11510-1910
US

V. Phone/Fax

Practice location:
  • Phone: 516-223-0670
  • Fax: 516-223-0905
Mailing address:
  • Phone: 516-867-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number052231-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: