Healthcare Provider Details

I. General information

NPI: 1396067195
Provider Name (Legal Business Name): GERALD NEIL KOBLIN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 MAIN ST
NYACK NY
10960-3110
US

IV. Provider business mailing address

96 MAIN ST
NYACK NY
10960-3110
US

V. Phone/Fax

Practice location:
  • Phone: 845-358-0688
  • Fax: 845-358-7966
Mailing address:
  • Phone: 845-358-0688
  • Fax: 845-358-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23748
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3821
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: