Provider Demographics
NPI:1629392345
Name:KOZARITS, SHANNON (RPH)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:KOZARITS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 EMPIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1903
Mailing Address - Country:US
Mailing Address - Phone:585-671-4070
Mailing Address - Fax:585-671-1995
Practice Address - Street 1:1955 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1903
Practice Address - Country:US
Practice Address - Phone:585-671-4070
Practice Address - Fax:585-671-1995
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist