Provider Demographics
NPI:1205161775
Name:KOSHLAND PHARMACY INC
Entity type:Organization
Organization Name:KOSHLAND PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-318-2852
Mailing Address - Street 1:301 FOLSOM ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-2308
Mailing Address - Country:US
Mailing Address - Phone:415-344-0600
Mailing Address - Fax:415-344-0607
Practice Address - Street 1:301 FOLSOM ST STE B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-2309
Practice Address - Country:US
Practice Address - Phone:415-344-0600
Practice Address - Fax:415-344-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
CAPHY500413336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122390OtherPK