Provider Demographics
NPI:1467925560
Name:KOZAKI, COLTEN KEANU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COLTEN
Middle Name:KEANU
Last Name:KOZAKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5681 DESERT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7239
Mailing Address - Country:US
Mailing Address - Phone:808-281-7675
Mailing Address - Fax:
Practice Address - Street 1:2662 DEL MAR HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3100
Practice Address - Country:US
Practice Address - Phone:808-281-7675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist