Healthcare Provider Details

I. General information

NPI: 1619150919
Provider Name (Legal Business Name): ROBERT J KOZIOL PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20751 HOLYOKE AVE BOX 808
LAKEVILLE MN
55044-0808
US

IV. Provider business mailing address

20751 HOLYOKE AVE PO BOX 808
LAKEVILLE MN
55044-0808
US

V. Phone/Fax

Practice location:
  • Phone: 952-469-2964
  • Fax: 952-469-6753
Mailing address:
  • Phone: 952-469-2964
  • Fax: 952-469-6753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number112443
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: