Provider Demographics
NPI:1982988705
Name:KOSSILOS, MARIA (RPH)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:KOSSILOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 CAMBRIDGE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1154
Mailing Address - Country:US
Mailing Address - Phone:617-806-8505
Mailing Address - Fax:617-806-8525
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:OUTPATIENT PHARMACY, 2ND FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-1438
Practice Address - Fax:617-665-1148
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist