Provider Demographics
NPI:1043494131
Name:KOCIS, PAUL THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:KOCIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-7023
Mailing Address - Country:US
Mailing Address - Phone:717-309-1665
Mailing Address - Fax:717-566-2384
Practice Address - Street 1:1952 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-7023
Practice Address - Country:US
Practice Address - Phone:717-309-1665
Practice Address - Fax:717-566-2384
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-25
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-036006-L183500000X
OH03-1-17698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist