Healthcare Provider Details

I. General information

NPI: 1295361657
Provider Name (Legal Business Name): PAWEL KOJS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 MAIN ST
FERNDALE WA
98248-9454
US

IV. Provider business mailing address

1815 MAIN ST
FERNDALE WA
98248-9454
US

V. Phone/Fax

Practice location:
  • Phone: 360-380-7210
  • Fax:
Mailing address:
  • Phone: 360-380-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61001146
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: