Provider Demographics
NPI:1073650230
Name:KOCSIS, MARIANN
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:KOCSIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 REUBEN DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4928
Mailing Address - Country:US
Mailing Address - Phone:775-828-4280
Mailing Address - Fax:
Practice Address - Street 1:34 RESERVATION RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1521
Practice Address - Country:US
Practice Address - Phone:775-329-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR44281835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy