Provider Demographics
NPI:1275742124
Name:KOCH, CYNTHIA JEAN (BS)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JEAN
Last Name:KOCH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VT
Mailing Address - Zip Code:05089-1267
Mailing Address - Country:US
Mailing Address - Phone:802-674-6895
Mailing Address - Fax:
Practice Address - Street 1:6 COURT ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089-1267
Practice Address - Country:US
Practice Address - Phone:802-674-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist