Provider Demographics
NPI:1932440583
Name:KOO, PETER AH-MING
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:AH-MING
Last Name:KOO
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 1:13324A 41ST AVE
Mailing Address - Street 2:STARSIDE DRUGS
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3629
Mailing Address - Country:US
Mailing Address - Phone:718-961-2931
Mailing Address - Fax:
Practice Address - Street 1:13636 39TH AVE
Practice Address - Street 2:STARSIDE DRUGS
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5599
Practice Address - Country:US
Practice Address - Phone:718-321-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist