Healthcare Provider Details

I. General information

NPI: 1306709266
Provider Name (Legal Business Name): JEFFIN K KOSHY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N86W12999 NIGHTINGALE WAY
MENOMONEE FALLS WI
53051-2102
US

IV. Provider business mailing address

630 LONGFORD DR
DES PLAINES IL
60016-8743
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-5690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2319440
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32494
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051305808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: