Provider Demographics
NPI:1013494277
Name:KOWCZ, ROMAN (RPH)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:KOWCZ
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 1:1360 E TOWN RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3623
Mailing Address - Country:US
Mailing Address - Phone:203-877-1912
Mailing Address - Fax:203-874-7438
Practice Address - Street 1:1360 E TOWN RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3623
Practice Address - Country:US
Practice Address - Phone:203-877-1912
Practice Address - Fax:203-874-7438
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist