Active NPI
Tony Koehn
- Pharmacist
- Detroit, MI
National Provider Identifier
1457833303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302041464
- Practice address
- 3990 John R St
Detroit, MI 48201-2018 - Phone
- (313) 745-8395
- NPI assigned
- Sep 6, 2018
- Last updated
- Sep 6, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0015652 | OR | |
| Pharmacist | 183500000X | 5302041464 | MI | Primary |
Addresses
Primary practice location
3990 John R St
Detroit, MI 48201-2018
Mailing address
1418 Cobblestone CT
Ann Arbor, MI 48108-9553
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302041464 | MI | MD | Pharmacist |
| RPH-0015652 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536192000000",
"number": "1457833303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1418 COBBLESTONE CT",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481089553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3990 JOHN R ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012018",
"telephone_number": "313-745-8395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEHN",
"first_name": "TONY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-06",
"last_updated": "2018-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0015652",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302041464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.