Provider Demographics
NPI:1104818772
Name:KOHLERMAN PHARMACY INC
Entity type:Organization
Organization Name:KOHLERMAN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOHLERMAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-647-2266
Mailing Address - Street 1:101 W KING ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2411
Mailing Address - Country:US
Mailing Address - Phone:610-647-2266
Mailing Address - Fax:610-647-2290
Practice Address - Street 1:101 W KING ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2411
Practice Address - Country:US
Practice Address - Phone:610-647-2266
Practice Address - Fax:610-647-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP11270L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0542580001Medicare NSC