Individual
KO KO LATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPHT
Contact information
Practice address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 334-2451
Mailing address
7901 BROADWAY, ELMHURST, NY 11373-1329
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
001787
NY
Other
Enumeration date
12/14/2022
Last updated
12/14/2022
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