Provider Demographics
NPI:1255717195
Name:KOWALSKI, RICHARD CASEY (PHARMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CASEY
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2319
Mailing Address - Country:US
Mailing Address - Phone:310-435-8892
Mailing Address - Fax:213-201-1437
Practice Address - Street 1:611 S KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2319
Practice Address - Country:US
Practice Address - Phone:213-201-1437
Practice Address - Fax:213-201-1437
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH72855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist