Provider Demographics
NPI:1235791583
Name:KOH, PHILIP
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:KOH
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 1:6 PUMPHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-2903
Mailing Address - Country:US
Mailing Address - Phone:646-552-4826
Mailing Address - Fax:
Practice Address - Street 1:3050 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8154
Practice Address - Country:US
Practice Address - Phone:718-882-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-07
Last Update Date:2023-12-12
Deactivation Date:2021-04-06
Deactivation Code:
Reactivation Date:2021-12-08
Provider Licenses
StateLicense IDTaxonomies
NY055056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist