Provider Demographics
NPI:1699980177
Name:KOVALESKI, CARL (RPH)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:KOVALESKI
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 1:1811 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-8536
Mailing Address - Country:US
Mailing Address - Phone:812-254-6164
Mailing Address - Fax:
Practice Address - Street 1:1811 WOODLAWN DRIVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501
Practice Address - Country:US
Practice Address - Phone:812-254-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist