Provider Demographics
NPI:1013534429
Name:KOZIK, LEAH JANICE (RPH)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:JANICE
Last Name:KOZIK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 S LOOP 256
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5919
Mailing Address - Country:US
Mailing Address - Phone:903-723-1092
Mailing Address - Fax:903-729-2652
Practice Address - Street 1:2107 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5919
Practice Address - Country:US
Practice Address - Phone:903-723-1092
Practice Address - Fax:903-729-2652
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty