Healthcare Provider Details

I. General information

NPI: 1295326080
Provider Name (Legal Business Name): GEORGE MATTHEW KOWALSKI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7512 W TUCKAWAY PINES CIR
FRANKLIN WI
53132-8178
US

IV. Provider business mailing address

7512 W TUCKAWAY PINES CIR
FRANKLIN WI
53132-8178
US

V. Phone/Fax

Practice location:
  • Phone: 414-617-3619
  • Fax:
Mailing address:
  • Phone: 414-617-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62062
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19503-40
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRI19217
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: