Healthcare Provider Details

I. General information

NPI: 1831499656
Provider Name (Legal Business Name): DANIEL KOCIELA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E US HIGHWAY 24
WOODLAND PARK CO
80863-2121
US

IV. Provider business mailing address

1101 E US HIGHWAY 24
WOODLAND PARK CO
80863-2121
US

V. Phone/Fax

Practice location:
  • Phone: 719-686-9161
  • Fax: 719-686-1698
Mailing address:
  • Phone: 719-686-9161
  • Fax: 719-686-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10775
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: