MEDICARE: KOCH PHARMACY CORP

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	333600000X	Pharmacy	025408	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982741377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOCH PHARMACY CORP

Provider Business Mailing Address
First Line	:	126 WYCKOFF AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4308
Country	:	US
Telephone Number	:	718-381-0120
Fax Number	:	718-381-5780

Provider Business Practice Location Address
First Line	:	126 WYCKOFF AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4308
Country	:	US
Telephone Number	:	718-381-0120
Fax Number	:	718-381-5780

Authorized Official
Title or Position	:	VICE PRESIDENT DIRECTOR OF PHARMACY
Name	:	MR. ABU J SIDDIQUE
Credential	:	RPH
Telephone Number	:	718-381-0120

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	02/25/2011

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Directions to “KOCH PHARMACY CORP ” Practice Location

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