Provider Demographics
NPI:1134390198
Name:KOGUT, ANDREW PETER (RPH)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:PETER
Last Name:KOGUT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:36 OLD BRICK RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1817
Mailing Address - Country:US
Mailing Address - Phone:516-621-3202
Mailing Address - Fax:718-445-8250
Practice Address - Street 1:3515 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1955
Practice Address - Country:US
Practice Address - Phone:718-539-7752
Practice Address - Fax:718-445-8250
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033803-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist