Provider Demographics
NPI:1740943125
Name:KOKOSZKA, ROBERT TAYLOR (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TAYLOR
Last Name:KOKOSZKA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 DAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:TN
Mailing Address - Zip Code:37415-7124
Mailing Address - Country:US
Mailing Address - Phone:423-870-0859
Mailing Address - Fax:
Practice Address - Street 1:4039 DAYTON BLVD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:TN
Practice Address - Zip Code:37415-7124
Practice Address - Country:US
Practice Address - Phone:423-870-0859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist