Provider Demographics
NPI:1932330172
Name:KOCH, MICHAEL WILLIAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:KOCH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-5716
Mailing Address - Country:US
Mailing Address - Phone:336-476-1133
Mailing Address - Fax:336-476-1136
Practice Address - Street 1:901 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5716
Practice Address - Country:US
Practice Address - Phone:336-476-1133
Practice Address - Fax:336-476-1136
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist