1881139376 NPI number — MRS. JAMIE LYNN KOO PHARMD

Table of content: MRS. JAMIE LYNN KOO PHARMD (NPI 1881139376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881139376 NPI number — MRS. JAMIE LYNN KOO PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOO
Provider First Name:
JAMIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAASE
Provider Other First Name:
JAMIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881139376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 W KINGSBRIDGE RD
Provider Second Line Business Mailing Address:
PHARMACY DEPARTMENT
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-584-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 W KINGSBRIDGE RD
Provider Second Line Business Practice Location Address:
PHARMACY DEPARTMENT
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-584-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  061471 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 5302040815 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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