Healthcare Provider Details

I. General information

NPI: 1912905274
Provider Name (Legal Business Name): MARYLOU KOSMATKA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELLIOT WAY ELLIOT HOSPITAL PHARMACY
MANCHESTER NH
03103-3502
US

IV. Provider business mailing address

46 WHEELER RD
HOLLIS NH
03049-5926
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-2404
  • Fax: 603-663-3987
Mailing address:
  • Phone: 603-465-2010
  • Fax: 603-465-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2210
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: