Provider Demographics
NPI:1093309734
Name:KOSKO, WESLEY ALLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:ALLEN
Last Name:KOSKO
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 1:7575 W 106TH ST APT 425
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-5915
Mailing Address - Country:US
Mailing Address - Phone:218-760-9584
Mailing Address - Fax:
Practice Address - Street 1:6860 W 115TH ST STE 150
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-2454
Practice Address - Country:US
Practice Address - Phone:855-427-4682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15965183500000X
MO2014024149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist