Provider Demographics
NPI:1669566154
Name:KOSTEK, NICHOLAS E (RPH, MS)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:E
Last Name:KOSTEK
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1800 HARRISON ST
Mailing Address - Street 2:SUITE 1301
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3466
Mailing Address - Country:US
Mailing Address - Phone:510-625-3715
Mailing Address - Fax:510-625-3734
Practice Address - Street 1:1800 HARRISON ST
Practice Address - Street 2:SUITE 1301
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3466
Practice Address - Country:US
Practice Address - Phone:510-625-3715
Practice Address - Fax:510-625-3734
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist