Provider Demographics
NPI:1699469791
Name:KOU, JOHN SAMUEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SAMUEL
Last Name:KOU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 GABLE LANE CT APT 1035
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-6341
Mailing Address - Country:US
Mailing Address - Phone:978-806-1755
Mailing Address - Fax:
Practice Address - Street 1:10845 E 79TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8919
Practice Address - Country:US
Practice Address - Phone:317-826-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030220A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist