Provider Demographics
NPI:1659975845
Name:KOO, HANNA J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HANNA
Middle Name:J
Last Name:KOO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2176
Mailing Address - Country:US
Mailing Address - Phone:201-708-5387
Mailing Address - Fax:
Practice Address - Street 1:1475 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2176
Practice Address - Country:US
Practice Address - Phone:201-947-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03649800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist