Healthcare Provider Details

I. General information

NPI: 1841576857
Provider Name (Legal Business Name): ANNIE T KOSEL PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16167 PINKNEY ST
OMAHA NE
68116-6440
US

IV. Provider business mailing address

16167 PINKNEY ST
OMAHA NE
68116-6440
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-7290
  • Fax:
Mailing address:
  • Phone: 402-502-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number11757
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: