Provider Demographics
NPI:1407091093
Name:KOLCESKI, DANIEL R (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:KOLCESKI
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:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-0103
Mailing Address - Country:US
Mailing Address - Phone:315-697-5255
Mailing Address - Fax:315-697-5255
Practice Address - Street 1:10 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2568
Practice Address - Country:US
Practice Address - Phone:315-697-5255
Practice Address - Fax:315-697-5255
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist