Healthcare Provider Details

I. General information

NPI: 1780098624
Provider Name (Legal Business Name): GREGORY A KOZENY JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 S ARIZONA AVE
CHANDLER AZ
85248-5021
US

IV. Provider business mailing address

4990 S ARIZONA AVE
CHANDLER AZ
85248-5021
US

V. Phone/Fax

Practice location:
  • Phone: 480-802-6748
  • Fax:
Mailing address:
  • Phone: 480-802-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI011442
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: