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NPI Code Detail

MEDICARE: KOACH3 INC

MEDICARE: KOACH3 INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy5301009312MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12374039OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1306164140
Entity Type Code : Organization
Provider Name (Legal Business Name) : KOACH3 INC
Provider Business Mailing Address
First Line : 9600 DEXTER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48206-1816
Country : US
Telephone Number : 313-870-9201
Fax Number : 313-870-9207
Provider Business Practice Location Address
First Line : 9600 DEXTER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48206-1816
Country : US
Telephone Number : 313-870-9201
Fax Number : 313-870-9207
Authorized Official
Title or Position : PRESIDENT
Name : KOMAL ACHARYA
Credential :
Telephone Number : 313-870-9201
Provider Enumeration Date : 05/04/2010
Last Update Date : 06/14/2011

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Directions to “KOACH3 INC ” Practice Location

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