Provider Demographics
NPI:1285903807
Name:KOINANGE, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KOINANGE
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 1:416 ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2711
Mailing Address - Country:US
Mailing Address - Phone:831-644-9057
Mailing Address - Fax:831-644-9104
Practice Address - Street 1:416 ALVARADO ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2711
Practice Address - Country:US
Practice Address - Phone:831-644-9057
Practice Address - Fax:831-644-9104
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57985183500000X
AZS015859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist