Healthcare Provider Details

I. General information

NPI: 1275742124
Provider Name (Legal Business Name): CYNTHIA JEAN KOCH B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 COURT ST
WINDSOR VT
05089-1267
US

IV. Provider business mailing address

6 COURT ST
WINDSOR VT
05089-1267
US

V. Phone/Fax

Practice location:
  • Phone: 802-674-6895
  • Fax:
Mailing address:
  • Phone: 802-674-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3055
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: