Healthcare Provider Details

I. General information

NPI: 1750160453
Provider Name (Legal Business Name): ROBERT KOZIOL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 BOYLSTON ST
BOSTON MA
02215-3909
US

IV. Provider business mailing address

17 ALLEN ST
CAMBRIDGE MA
02140-1315
US

V. Phone/Fax

Practice location:
  • Phone: 857-317-5221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH997122
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: