Provider Demographics
NPI:1043824790
Name:KOCH, TRENEE NICOLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TRENEE
Middle Name:NICOLE
Last Name:KOCH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 WASHINGTON CORS
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4603
Mailing Address - Country:US
Mailing Address - Phone:217-820-9929
Mailing Address - Fax:
Practice Address - Street 1:890 WASHINGTON CORS
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4603
Practice Address - Country:US
Practice Address - Phone:636-239-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015009855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist