MEDICARE: JONATHAN KOSHY

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	069083	NY

General Provider Information

NPI Number	:	1477281855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN KOSHY

Provider Business Mailing Address
First Line	:	304 CRITTENDEN WAY APT 1
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-2227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 N CLINTON AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-4526
Country	:	US
Telephone Number	:	585-544-8210
Fax Number	:

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	08/12/2022

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Directions to “ JONATHAN KOSHY ” Practice Location

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