Provider Demographics
NPI:1265446082
Name:KOO & CO., INC
Entity Type:Organization
Organization Name:KOO & CO., INC
Other - Org Name:STARSIDE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-961-2931
Mailing Address - Street 1:13636 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5516
Mailing Address - Country:US
Mailing Address - Phone:718-321-1716
Mailing Address - Fax:718-321-1528
Practice Address - Street 1:13636 39TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5516
Practice Address - Country:US
Practice Address - Phone:718-321-1716
Practice Address - Fax:718-321-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0253753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02269592Medicaid
NY3325897OtherNABP
NY4497260001Medicare NSC