Healthcare Provider Details

I. General information

NPI: 1710200563
Provider Name (Legal Business Name): JULIANNE EILEEN KOCH PHARM.D.,RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CENTRAL PLZ
ILION NY
13357-1701
US

IV. Provider business mailing address

3367 STATE ROUTE 167
LITTLE FALLS NY
13365-5329
US

V. Phone/Fax

Practice location:
  • Phone: 315-894-9995
  • Fax:
Mailing address:
  • Phone: 315-717-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: