Provider Demographics
NPI:1629507082
Name:KOOGLER, CHRISTOPH SCOTT
Entity Type:Individual
Prefix:
First Name:CHRISTOPH
Middle Name:SCOTT
Last Name:KOOGLER
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 1:165 VAUGHAN LN
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-7808
Mailing Address - Country:US
Mailing Address - Phone:205-338-5312
Mailing Address - Fax:205-338-5315
Practice Address - Street 1:165 VAUGHN LANE
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125
Practice Address - Country:US
Practice Address - Phone:205-338-5312
Practice Address - Fax:205-338-5315
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist