Healthcare Provider Details

I. General information

NPI: 1922668219
Provider Name (Legal Business Name): ANDREA KOWALSKI RPH, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S BUCKEYE ST
CROOKSVILLE OH
43731-1015
US

IV. Provider business mailing address

364 FRANKLIN CT
WORTHINGTON OH
43085-3143
US

V. Phone/Fax

Practice location:
  • Phone: 740-982-8158
  • Fax:
Mailing address:
  • Phone: 330-289-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03234020
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: