Provider Demographics
NPI:1538639786
Name:KOWALSKI, KORY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:KOWALSKI
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 1:103 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-4040
Mailing Address - Country:US
Mailing Address - Phone:218-790-1482
Mailing Address - Fax:
Practice Address - Street 1:3175 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6171
Practice Address - Country:US
Practice Address - Phone:701-293-6022
Practice Address - Fax:701-293-6040
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120806183500000X
NDRPH5550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty