Healthcare Provider Details

I. General information

NPI: 1164060745
Provider Name (Legal Business Name): COZI WILSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2019
Last Update Date: 11/27/2023
Certification Date: 12/14/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W CENTRAL AVE
COMANCHE TX
76442-2706
US

IV. Provider business mailing address

404 W CENTRAL AVE
COMANCHE TX
76442-2706
US

V. Phone/Fax

Practice location:
  • Phone: 325-356-5276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39257
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: