Healthcare Provider Details

I. General information

NPI: 1215303748
Provider Name (Legal Business Name): NATHALIE DANIELLE KOCON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WILDWOOD LN
MOUNTAIN TOP PA
18707-9663
US

IV. Provider business mailing address

5 WILDWOOD LN
MOUNTAIN TOP PA
18707-9663
US

V. Phone/Fax

Practice location:
  • Phone: 570-899-6946
  • Fax:
Mailing address:
  • Phone: 570-899-6046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP450010
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: