Provider Demographics
NPI:1366508392
Name:KOZAL, ANNE MARIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MARIE
Last Name:KOZAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2680 LEONARD ST NE STE 5
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6901
Mailing Address - Country:US
Mailing Address - Phone:616-369-6401
Mailing Address - Fax:616-315-2646
Practice Address - Street 1:2680 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6934
Practice Address - Country:US
Practice Address - Phone:616-224-1121
Practice Address - Fax:616-224-3001
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist