Provider Demographics
NPI:1285132480
Name:KOSHO, BIANCA DURAID (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:DURAID
Last Name:KOSHO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:BIANCA
Other - Middle Name:DURAID
Other - Last Name:KILANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:16211 VIA MONTELLA
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-1039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2971 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7032
Practice Address - Country:US
Practice Address - Phone:248-288-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist