Provider Demographics
NPI:1407024722
Name:KOEHLER, BRIAN DAVID (RPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304
Mailing Address - Country:US
Mailing Address - Phone:518-393-2173
Mailing Address - Fax:518-393-4438
Practice Address - Street 1:1340 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2721
Practice Address - Country:US
Practice Address - Phone:518-393-2173
Practice Address - Fax:518-393-4438
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00461587Medicaid