Provider Demographics
NPI:1508249111
Name:KOSISKO, JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:KOSISKO
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 1:200 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-2654
Mailing Address - Country:US
Mailing Address - Phone:724-628-8460
Mailing Address - Fax:
Practice Address - Street 1:200 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-2654
Practice Address - Country:US
Practice Address - Phone:724-628-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038311L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist