Provider Demographics
NPI:1891102976
Name:KOCH, CASEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:KOCH
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 1:1919 AKSARBEN DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-4206
Mailing Address - Country:US
Mailing Address - Phone:402-982-6595
Mailing Address - Fax:
Practice Address - Street 1:1919 AKSARBEN DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-4206
Practice Address - Country:US
Practice Address - Phone:402-982-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist