Provider Demographics
NPI:1730458555
Name:KOSEK, ROBERT GEORGE
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GEORGE
Last Name:KOSEK
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 1:13551 MCGREGOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-6044
Mailing Address - Country:US
Mailing Address - Phone:239-437-4042
Mailing Address - Fax:
Practice Address - Street 1:13551 MCGREGOR BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-6044
Practice Address - Country:US
Practice Address - Phone:239-437-4042
Practice Address - Fax:239-437-4516
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist