Provider Demographics
NPI:1629833819
Name:MACHLUS, KOEHLER ZAKAI
Entity Type:Individual
Prefix:
First Name:KOEHLER
Middle Name:ZAKAI
Last Name:MACHLUS
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 1:1843 WHITEWILLOW DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5483
Mailing Address - Country:US
Mailing Address - Phone:813-244-6351
Mailing Address - Fax:
Practice Address - Street 1:1504 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4248
Practice Address - Country:US
Practice Address - Phone:941-752-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist