Provider Demographics
NPI:1619571569
Name:KOTASKA, CHRIS M (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:M
Last Name:KOTASKA
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 1:5903 WESSEX CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5455
Mailing Address - Country:US
Mailing Address - Phone:214-563-5417
Mailing Address - Fax:
Practice Address - Street 1:1540 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-4486
Practice Address - Country:US
Practice Address - Phone:214-383-9765
Practice Address - Fax:214-383-9771
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist