Provider Demographics
NPI:1104517440
Name:KOEHLER, DHARMISTA R (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:DHARMISTA
Middle Name:R
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 BEDELL RD APT 6
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1685
Mailing Address - Country:US
Mailing Address - Phone:813-263-6461
Mailing Address - Fax:
Practice Address - Street 1:2159 BEDELL RD APT 6
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1685
Practice Address - Country:US
Practice Address - Phone:813-263-6461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist