Provider Demographics
NPI:1588988372
Name:KOZLOSKI, DAVID A
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:KOZLOSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100I COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-3122
Mailing Address - Country:US
Mailing Address - Phone:973-890-7735
Mailing Address - Fax:
Practice Address - Street 1:100I COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-3122
Practice Address - Country:US
Practice Address - Phone:973-890-7735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI02599500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist