Provider Demographics
NPI:1164789855
Name:KOZMA, PAUL DENNIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DENNIS
Last Name:KOZMA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5340 LORAINE DR
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53021-9765
Mailing Address - Country:US
Mailing Address - Phone:262-692-3715
Mailing Address - Fax:
Practice Address - Street 1:2615 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-4270
Practice Address - Country:US
Practice Address - Phone:920-892-4182
Practice Address - Fax:920-893-5973
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2972183500000X
CO13237183500000X
ND4063183500000X
WI10884183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy