Provider Demographics
NPI:1427647866
Name:LOSAK, JOHN CAMERON (CPHT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CAMERON
Last Name:LOSAK
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 W MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-7137
Mailing Address - Country:US
Mailing Address - Phone:254-379-4736
Mailing Address - Fax:
Practice Address - Street 1:1821 S VALLEY MILLS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-2118
Practice Address - Country:US
Practice Address - Phone:254-757-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician