Provider Demographics
NPI:1942537550
Name:MAGOSI, KGOMOTSO (PHAMD)
Entity Type:Individual
Prefix:
First Name:KGOMOTSO
Middle Name:
Last Name:MAGOSI
Suffix:
Gender:M
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13260 JOSEY LN
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-4973
Mailing Address - Country:US
Mailing Address - Phone:972-247-3421
Mailing Address - Fax:972-247-1469
Practice Address - Street 1:13260 JOSEY LN
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-4973
Practice Address - Country:US
Practice Address - Phone:972-247-3421
Practice Address - Fax:972-247-1469
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist