Healthcare Provider Details

I. General information

NPI: 1639276884
Provider Name (Legal Business Name): JANINE CAROL KOZAK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 IRVING AVE SYRACUSE VA MEDICAL CENTER
SYRACUSE NY
13210-2716
US

IV. Provider business mailing address

8447 LAKESHORE RD
CICERO NY
13039-9720
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-4400
  • Fax: 315-425-2452
Mailing address:
  • Phone: 315-699-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: