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General NPI Number Information
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NPI Number | 1982741377
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Entity Type | Organization
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Legal Business Name | KOCH PHARMACY CORP
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 126 WYCKOFF AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-4308
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Country | US
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Telephone | 718-381-0120
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Fax | 718-381-5780
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Provider Business Mailing Address
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Address Line | 126 WYCKOFF AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-4308
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Country | US
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Telephone | 718-381-0120
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Fax | 718-381-5780
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Authorized Official
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Title or Position | VICE PRESIDENT DIRECTOR OF PHARMACY
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Name | MR. ABU J SIDDIQUE
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Credential | RPH
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Telephone | 718-381-0120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 025408
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License Number State | NY
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