Provider Demographics
NPI:1245889575
Name:KOTHE, CHRISTOPH PETER
Entity type:Individual
Prefix:
First Name:CHRISTOPH
Middle Name:PETER
Last Name:KOTHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 CAZENOVIA RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-8726
Mailing Address - Country:US
Mailing Address - Phone:315-382-9153
Mailing Address - Fax:
Practice Address - Street 1:8230 CAZENOVIA RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-8726
Practice Address - Country:US
Practice Address - Phone:315-682-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist