Provider Demographics
NPI:1023565066
Name:KOERNER, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KOERNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2364
Mailing Address - Country:US
Mailing Address - Phone:206-329-6850
Mailing Address - Fax:
Practice Address - Street 1:9600 PARKSOUTH CT STE 120
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6424
Practice Address - Country:US
Practice Address - Phone:877-453-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60674220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist