Healthcare Provider Details

I. General information

NPI: 1720360191
Provider Name (Legal Business Name): MICHAEL JOSEPH KOCH PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 S BELLEVUE BLVD
MEMPHIS TN
38106-2331
US

IV. Provider business mailing address

1130 S BELLEVUE BLVD
MEMPHIS TN
38106-2331
US

V. Phone/Fax

Practice location:
  • Phone: 901-946-3676
  • Fax: 901-948-9996
Mailing address:
  • Phone: 901-946-3676
  • Fax: 901-948-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24537
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: