Healthcare Provider Details

I. General information

NPI: 1356510218
Provider Name (Legal Business Name): MICHAEL THOMAS KOWALSKI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 TROY SCHENECTADY RD
LATHAM NY
12110-2806
US

IV. Provider business mailing address

1146 DIANNE CT
SCHENECTADY NY
12303-3300
US

V. Phone/Fax

Practice location:
  • Phone: 518-783-4397
  • Fax:
Mailing address:
  • Phone: 518-952-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048613
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: