Provider Demographics
NPI:1417336322
Name:KOZEK, JENNIFER ANNIE (PHARMD,RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNIE
Last Name:KOZEK
Suffix:
Gender:F
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 AYERS LN
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2202
Mailing Address - Country:US
Mailing Address - Phone:908-451-7556
Mailing Address - Fax:
Practice Address - Street 1:78 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1640
Practice Address - Country:US
Practice Address - Phone:908-782-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03012000183500000X
NJ28RJ01834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist