Provider Demographics
NPI:1902376403
Name:KOKINDA, MARUTA ANNA
Entity Type:Individual
Prefix:
First Name:MARUTA
Middle Name:ANNA
Last Name:KOKINDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WEIS LN
Mailing Address - Street 2:
Mailing Address - City:WEST HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1207
Mailing Address - Country:US
Mailing Address - Phone:570-455-6670
Mailing Address - Fax:570-455-8866
Practice Address - Street 1:100 WEIS LN
Practice Address - Street 2:
Practice Address - City:WEST HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1207
Practice Address - Country:US
Practice Address - Phone:570-455-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028599L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist