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General NPI Number Information
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NPI Number | 1306164140
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Entity Type | Organization
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Legal Business Name | KOACH3 INC
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 9600 DEXTER AVE
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City | DETROIT
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State | MI
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Zip | 48206-1816
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Country | US
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Telephone | 313-870-9201
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Fax | 313-870-9207
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Provider Business Mailing Address
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Address Line | 9600 DEXTER AVE
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City | DETROIT
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State | MI
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Zip | 48206-1816
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Country | US
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Telephone | 313-870-9201
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Fax | 313-870-9207
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Authorized Official
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Title or Position | PRESIDENT
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Name | KOMAL ACHARYA
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Credential |
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Telephone | 313-870-9201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009312
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License Number State | MI
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