Provider Demographics
NPI:1710008602
Name:KOCIS, FRANK
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:KOCIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:MI
Mailing Address - Zip Code:48097-3317
Mailing Address - Country:US
Mailing Address - Phone:810-387-4244
Mailing Address - Fax:810-387-2605
Practice Address - Street 1:25 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:MI
Practice Address - Zip Code:48097-3317
Practice Address - Country:US
Practice Address - Phone:810-387-4244
Practice Address - Fax:810-387-2605
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302019663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302019663OtherPHARMACIST