Provider Demographics
NPI:1912139270
Name:KOHEN PHARMACY & MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:KOHEN PHARMACY & MEDICAL SUPPLY LLC
Other - Org Name:KOHEN PHARMACY & MEDICAL SUPPLY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHCY MGR
Authorized Official - Prefix:
Authorized Official - First Name:KWEKU
Authorized Official - Middle Name:
Authorized Official - Last Name:OHENE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:856-885-6813
Mailing Address - Street 1:3101 BLACK HORSE PIKE
Mailing Address - Street 2:UNIT 9
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5116
Mailing Address - Country:US
Mailing Address - Phone:856-302-5825
Mailing Address - Fax:856-302-5835
Practice Address - Street 1:3101 BLACK HORSE PIKE
Practice Address - Street 2:UNIT 9
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5116
Practice Address - Country:US
Practice Address - Phone:856-302-5825
Practice Address - Fax:856-302-5835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006963003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3196448OtherNCPDP PROVIDER IDENTIFICATION NUMBER