Healthcare Provider Details

I. General information

NPI: 1568783504
Provider Name (Legal Business Name): JOANNE AGUA KOZEL PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNE KATHLEEN AGUA PHARMACIST

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 E AVENIDA DE LOS ARBOLES
THOUSAND OAKS CA
91360-2933
US

IV. Provider business mailing address

387 E AVENIDA DE LOS ARBOLES
THOUSAND OAKS CA
91360-2933
US

V. Phone/Fax

Practice location:
  • Phone: 805-492-1559
  • Fax: 805-492-7281
Mailing address:
  • Phone: 805-492-1559
  • Fax: 805-492-7281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH36414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: