Healthcare Provider Details

I. General information

NPI: 1992023543
Provider Name (Legal Business Name): ROBERT JOHN KOCH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 HIGHLAND RD STE 1
TWINSBURG OH
44087-2244
US

IV. Provider business mailing address

1750 HIGHLAND RD STE 1
TWINSBURG OH
44087-2244
US

V. Phone/Fax

Practice location:
  • Phone: 330-425-8214
  • Fax: 180-053-3711
Mailing address:
  • Phone: 330-425-8214
  • Fax: 180-053-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number03-2-13826
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: