Provider Demographics
NPI:1013557784
Name:COZART, PAUL EVAN
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EVAN
Last Name:COZART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 W SMYTHE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-7410
Mailing Address - Country:US
Mailing Address - Phone:970-218-6631
Mailing Address - Fax:
Practice Address - Street 1:2301 W WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-5004
Practice Address - Country:US
Practice Address - Phone:509-327-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60966133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist