Provider Demographics
NPI:1205821840
Name:KOZEK, HENRY T (RPH, MPA)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:T
Last Name:KOZEK
Suffix:
Gender:M
Credentials:RPH, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4179 WINTHROP CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7611
Mailing Address - Country:US
Mailing Address - Phone:757-707-3344
Mailing Address - Fax:
Practice Address - Street 1:4179 WINTHROP CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7611
Practice Address - Country:US
Practice Address - Phone:757-707-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01394100183500000X
VA0202207627183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist