Provider Demographics
NPI:1467773697
Name:KOS, RICHARD M JR (PHARMD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:M
Last Name:KOS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3411
Mailing Address - Country:US
Mailing Address - Phone:252-443-3138
Mailing Address - Fax:252-443-6510
Practice Address - Street 1:3621 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3411
Practice Address - Country:US
Practice Address - Phone:252-443-3138
Practice Address - Fax:252-443-6510
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist