Provider Demographics
NPI:1164446647
Name:KOSAKOWSKI, ANA
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:
Last Name:KOSAKOWSKI
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 1:36711 AMERICAN WAY
Mailing Address - Street 2:PHARMACY DEPT
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011
Mailing Address - Country:US
Mailing Address - Phone:440-937-2350
Mailing Address - Fax:440-937-2355
Practice Address - Street 1:36711 AMERICAN WAY
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4045
Practice Address - Country:US
Practice Address - Phone:440-937-2350
Practice Address - Fax:440-937-2355
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-23938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist