Healthcare Provider Details

I. General information

NPI: 1902089139
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL KOTOWSKI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 ABBOTT RD
LACKAWANNA NY
14218-1910
US

IV. Provider business mailing address

1328 ABBOTT RD
LACKAWANNA NY
14218-1910
US

V. Phone/Fax

Practice location:
  • Phone: 716-828-1696
  • Fax: 716-828-1089
Mailing address:
  • Phone: 716-828-1696
  • Fax: 716-828-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: