Provider Demographics
NPI:1750726790
Name:KOKO, CHARLES BENJAMIN (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BENJAMIN
Last Name:KOKO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 CHASTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1275
Mailing Address - Country:US
Mailing Address - Phone:321-259-1364
Mailing Address - Fax:
Practice Address - Street 1:4719 CHASTAIN DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1275
Practice Address - Country:US
Practice Address - Phone:321-259-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist