Provider Demographics
NPI:1205212636
Name:PANICKER, ALEXANDER KOSHY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:KOSHY
Last Name:PANICKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CROWELL ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1702
Mailing Address - Country:US
Mailing Address - Phone:516-244-9798
Mailing Address - Fax:
Practice Address - Street 1:161 CROWELL ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1702
Practice Address - Country:US
Practice Address - Phone:516-244-9798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist