Healthcare Provider Details

I. General information

NPI: 1225315039
Provider Name (Legal Business Name): MARGARITA L KOTSOGIANNIS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 HOBOKEN RD
CARLSTADT NJ
07072-1143
US

IV. Provider business mailing address

637 HOBOKEN RD
CARLSTADT NJ
07072-1143
US

V. Phone/Fax

Practice location:
  • Phone: 201-842-0916
  • Fax: 201-842-0706
Mailing address:
  • Phone: 201-842-0916
  • Fax: 201-842-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02842300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: