Provider Demographics
NPI:1659558070
Name:KEOWONGWAN-COON, NAI (RPH)
Entity type:Individual
Prefix:MRS
First Name:NAI
Middle Name:
Last Name:KEOWONGWAN-COON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1423
Mailing Address - Country:US
Mailing Address - Phone:914-793-3933
Mailing Address - Fax:914-793-4751
Practice Address - Street 1:2262 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1423
Practice Address - Country:US
Practice Address - Phone:914-793-3933
Practice Address - Fax:914-793-4751
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist