Active NPI
Bon Gyeom Koo, PHARM D
- Pharmacist
- Hanover, MD
National Provider Identifier
1316565583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 27052
- Practice address
- 7706 Milestone Pkwy
Hanover, MD 21076-1754 - Phone
- (410) 799-2020
- NPI assigned
- Jul 13, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 27052 | MD | Primary |
Addresses
Primary practice location
7706 Milestone Pkwy
Hanover, MD 21076-1754
Mailing address
7694 Dorchester Blvd Apt 1102
Hanover, MD 21076-2066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27052 | MD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maryland CVS Pharmacy, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594598400000",
"number": "1316565583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7694 DORCHESTER BLVD APT 1102",
"city": "HANOVER",
"state": "MD",
"postal_code": "210762066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7706 MILESTONE PKWY",
"city": "HANOVER",
"state": "MD",
"postal_code": "210761754",
"telephone_number": "410-799-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOO",
"first_name": "BON GYEOM",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-13",
"last_updated": "2020-07-13",
"certification_date": "2020-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "27052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hanover, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.