Provider Demographics
NPI:1134445893
Name:KOH, PETER SONGWON (RPH)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:SONGWON
Last Name:KOH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:SONGWON
Other - Middle Name:
Other - Last Name:KOH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:200 BLAIR MILL RD
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-3053
Mailing Address - Country:US
Mailing Address - Phone:215-675-2265
Mailing Address - Fax:215-675-4702
Practice Address - Street 1:200 BLAIR MILL RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-3053
Practice Address - Country:US
Practice Address - Phone:215-675-2265
Practice Address - Fax:215-675-4702
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031217L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist