Provider Demographics
NPI:1558505644
Name:KOCH, DANIEL JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:KOCH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P711 COUNTY ROAD 16
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-7375
Mailing Address - Country:US
Mailing Address - Phone:419-966-6356
Mailing Address - Fax:
Practice Address - Street 1:P711 COUNTY ROAD 16
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-7375
Practice Address - Country:US
Practice Address - Phone:419-966-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03212824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist