Provider Demographics
NPI:1912905274
Name:KOSMATKA, MARYLOU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARYLOU
Middle Name:
Last Name:KOSMATKA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-5926
Mailing Address - Country:US
Mailing Address - Phone:603-465-2010
Mailing Address - Fax:603-465-6591
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:ELLIOT HOSPITAL PHARMACY
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-2404
Practice Address - Fax:603-663-3987
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22101835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy