Provider Demographics
NPI:1295326080
Name:KOWALSKI, GEORGE MATTHEW (RPH)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MATTHEW
Last Name:KOWALSKI
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 1:7512 W TUCKAWAY PINES CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8178
Mailing Address - Country:US
Mailing Address - Phone:414-617-3619
Mailing Address - Fax:
Practice Address - Street 1:7512 W TUCKAWAY PINES CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8178
Practice Address - Country:US
Practice Address - Phone:414-617-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62062183500000X
WI19503-40183500000X
NJRI19217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist