Provider Demographics
NPI:1558780718
Name:KOSKI, MICHAEL HAROLD (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HAROLD
Last Name:KOSKI
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 1:6055 NATHAN LANE N
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442
Mailing Address - Country:US
Mailing Address - Phone:763-463-4400
Mailing Address - Fax:
Practice Address - Street 1:6055 NATHAN LN N
Practice Address - Street 2:SUITE 200A
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-1674
Practice Address - Country:US
Practice Address - Phone:763-463-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist