Provider Demographics
NPI:1659458982
Name:KOZLOWSKI, JOHN T (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:KOZLOWSKI
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 1:500 FOWLER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-3326
Mailing Address - Country:US
Mailing Address - Phone:570-520-4170
Mailing Address - Fax:570-520-4179
Practice Address - Street 1:500 FOWLER AVE STE 202
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3326
Practice Address - Country:US
Practice Address - Phone:570-520-4170
Practice Address - Fax:570-520-4179
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038315L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist