Provider Demographics
NPI:1558547059
Name:COONS, PETER J (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:COONS
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 1:25 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:NY
Mailing Address - Zip Code:12015-1423
Mailing Address - Country:US
Mailing Address - Phone:518-945-1667
Mailing Address - Fax:518-945-1667
Practice Address - Street 1:25 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:NY
Practice Address - Zip Code:12015-1423
Practice Address - Country:US
Practice Address - Phone:518-945-1667
Practice Address - Fax:518-945-1667
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY31567OtherPHARMACY LICENSE NUMBER