Provider Demographics
NPI:1952814394
Name:KOCH, ZETHAN DANIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:ZETHAN
Middle Name:DANIEL
Last Name:KOCH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ORE HOLE RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16662-8136
Mailing Address - Country:US
Mailing Address - Phone:814-660-4502
Mailing Address - Fax:
Practice Address - Street 1:1516 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1752
Practice Address - Country:US
Practice Address - Phone:814-467-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist