Provider Demographics
NPI:1467728675
Name:KOSIROG, EMILY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:KOSIROG
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N BROADWAY FL 7
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3407
Mailing Address - Country:US
Mailing Address - Phone:303-602-7609
Mailing Address - Fax:
Practice Address - Street 1:601 N BROADWAY FL 7
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3407
Practice Address - Country:US
Practice Address - Phone:303-602-7609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024182A183500000X
COPHA.0019427183500000X, 1835P0018X
CO194271835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000216241Medicaid