1912139270 NPI number — KOHEN PHARMACY & MEDICAL SUPPLY LLC

Table of content: (NPI 1912139270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912139270 NPI number — KOHEN PHARMACY & MEDICAL SUPPLY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOHEN PHARMACY & MEDICAL SUPPLY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912139270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 BLACK HORSE PIKE
Provider Second Line Business Mailing Address:
UNIT 9
Provider Business Mailing Address City Name:
SICKLERVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08081-5116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-302-5825
Provider Business Mailing Address Fax Number:
856-302-5835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 BLACK HORSE PIKE
Provider Second Line Business Practice Location Address:
UNIT 9
Provider Business Practice Location Address City Name:
SICKLERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08081-5116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-302-5825
Provider Business Practice Location Address Fax Number:
856-302-5835
Provider Enumeration Date:
08/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
OHENE
Authorized Official First Name:
KWEKU
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHCY MGR
Authorized Official Telephone Number:
856-885-6813

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  28RS00696300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3196448 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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