Healthcare Provider Details

I. General information

NPI: 1912295957
Provider Name (Legal Business Name): MICHAEL GREGORY KOBILARCSIK JR. R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 D'AMANTE DRIVE
CONCORD NH
03301
US

IV. Provider business mailing address

80 D'AMANTE DRIVE
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-227-0816
  • Fax: 603-227-0816
Mailing address:
  • Phone: 603-227-0816
  • Fax: 603-227-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2778
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: