Provider Demographics
NPI:1558683854
Name:KOWIAK, BRUCE J (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:J
Last Name:KOWIAK
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 1:12 FRESH MEADOW RUN
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2817
Mailing Address - Country:US
Mailing Address - Phone:585-381-2906
Mailing Address - Fax:
Practice Address - Street 1:3 GEDDES STREET EXT
Practice Address - Street 2:
Practice Address - City:HOLLEY
Practice Address - State:NY
Practice Address - Zip Code:14470-1122
Practice Address - Country:US
Practice Address - Phone:585-638-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist