Provider Demographics
NPI:1588916704
Name:KOHLI, ASHOK (RPH)
Entity type:Individual
Prefix:
First Name:ASHOK
Middle Name:
Last Name:KOHLI
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 1:4039 CHICORA WOOD PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7696
Mailing Address - Country:US
Mailing Address - Phone:904-223-3555
Mailing Address - Fax:904-992-8220
Practice Address - Street 1:200 GLYNN ISLE PARKWAY
Practice Address - Street 2:MIKE KOHLI
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-2929
Practice Address - Country:US
Practice Address - Phone:912-261-4869
Practice Address - Fax:912-261-4879
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist