Healthcare Provider Details

I. General information

NPI: 1508856527
Provider Name (Legal Business Name): DANIEL WILLIAM KOSKI R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MAIN ST SUITE 103
MENDOTA HEIGHTS MN
55118-3764
US

IV. Provider business mailing address

750 MAIN ST SUITE 103
MENDOTA HEIGHTS MN
55118-3764
US

V. Phone/Fax

Practice location:
  • Phone: 651-455-6873
  • Fax: 651-451-7997
Mailing address:
  • Phone: 651-455-6873
  • Fax: 651-451-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1136601
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: