Provider Demographics
NPI:1013298371
Name:KOCESKI, JAY M (RPH)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:M
Last Name:KOCESKI
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 1:1950 WALES RD NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4110
Mailing Address - Country:US
Mailing Address - Phone:330-833-5730
Mailing Address - Fax:330-833-5779
Practice Address - Street 1:1950 WALES RD NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-4110
Practice Address - Country:US
Practice Address - Phone:330-833-5730
Practice Address - Fax:330-833-5779
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120397183500000X
PARP041319T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist