Healthcare Provider Details

I. General information

NPI: 1053324905
Provider Name (Legal Business Name): BRIAN CHRISTOPHER KOTANSKY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

708 MARPLE WOODS DR
SPRINGFIELD PA
19064-1047
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-6321
  • Fax: 215-823-4407
Mailing address:
  • Phone: 610-541-0577
  • Fax: 215-823-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP045175L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: