Healthcare Provider Details

I. General information

NPI: 1487061404
Provider Name (Legal Business Name): TAYLOR KOZLOWSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 GENESEE ST
UTICA NY
13501-4709
US

IV. Provider business mailing address

10530 COSBY MANOR RD
UTICA NY
13502-1208
US

V. Phone/Fax

Practice location:
  • Phone: 315-724-0125
  • Fax:
Mailing address:
  • Phone: 315-527-8126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059383
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: