Provider Demographics
NPI:1124467824
Name:KOTANSKY, JOSEPH MICHAEL (R PH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:KOTANSKY
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:SUITE K-114
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-773-1219
Mailing Address - Fax:760-773-4289
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:SUITE K-114
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-773-1219
Practice Address - Fax:760-773-4289
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist