Provider Demographics
NPI:1073194734
Name:KOH, DAVID W (RPH, PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:KOH
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810
Mailing Address - Country:US
Mailing Address - Phone:419-772-3956
Mailing Address - Fax:
Practice Address - Street 1:402 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-1269
Practice Address - Country:US
Practice Address - Phone:419-772-3956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist