Provider Demographics
NPI:1154605442
Name:KOSCINSKI, KENNETH W (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:W
Last Name:KOSCINSKI
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 1:1210 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2569
Mailing Address - Country:US
Mailing Address - Phone:724-652-0750
Mailing Address - Fax:724-652-0867
Practice Address - Street 1:1210 WILMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105
Practice Address - Country:US
Practice Address - Phone:724-652-0750
Practice Address - Fax:724-652-0867
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040911L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RPI000956OtherPHARMACY IMMUNIZER
PARP040911LOtherPHARMACY STATE LICENSE