Provider Demographics
NPI:1457916900
Name:KOCHANOFF, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:KOCHANOFF
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 1:10426 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2328
Mailing Address - Country:US
Mailing Address - Phone:718-533-0991
Mailing Address - Fax:718-424-5363
Practice Address - Street 1:10426 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2328
Practice Address - Country:US
Practice Address - Phone:718-533-0991
Practice Address - Fax:718-424-5363
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0567041UPD183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist