MEDICARE: DR. ELISHA KOHANBASH PHARM D.

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
1	183500000X	Pharmacist	062547	NY

General Provider Information

NPI Number	:	1396289641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISHA KOHANBASH PHARM D.

Provider Business Mailing Address
First Line	:	1649 E 37TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4220
Country	:	US
Telephone Number	:	347-628-3345
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1208
Country	:	US
Telephone Number	:	718-998-3377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	11/11/2020

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