Provider Demographics
NPI:1114166303
Name:SWANZIE, KOJO A
Entity Type:Individual
Prefix:DR
First Name:KOJO
Middle Name:A
Last Name:SWANZIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KOJO
Other - Middle Name:A
Other - Last Name:SWANZIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1287 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1910
Mailing Address - Country:US
Mailing Address - Phone:516-867-6705
Mailing Address - Fax:
Practice Address - Street 1:114 S LONG BEACH AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3441
Practice Address - Country:US
Practice Address - Phone:516-223-0670
Practice Address - Fax:516-223-0905
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052231-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist