Provider Demographics
NPI:1881139376
Name:KOO, JAMIE LYNN (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNN
Last Name:KOO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:HAASE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:130 W KINGSBRIDGE RD
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468
Mailing Address - Country:US
Mailing Address - Phone:718-584-9000
Mailing Address - Fax:
Practice Address - Street 1:130 W KINGSBRIDGE RD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061471183500000X
MI5302040815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist