Provider Demographics
NPI:1568783504
Name:KOZEL, JOANNE AGUA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:AGUA
Last Name:KOZEL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:KATHLEEN
Other - Last Name:AGUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:387 E AVENIDA DE LOS ARBOLES
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2933
Mailing Address - Country:US
Mailing Address - Phone:805-492-1559
Mailing Address - Fax:805-492-7281
Practice Address - Street 1:387 E AVENIDA DE LOS ARBOLES
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-2933
Practice Address - Country:US
Practice Address - Phone:805-492-1559
Practice Address - Fax:805-492-7281
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH36414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist