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General NPI Number Information
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NPI Number | 1164789855
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Entity Type | Individual
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Provider Name | PAUL DENNIS KOZMA RPH
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Gender | Male
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 2615 EASTERN AVE
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City | PLYMOUTH
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State | WI
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Zip | 53073-4270
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Country | US
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Telephone | 920-892-4182
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Fax | 920-893-5973
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Provider Business Mailing Address
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Address Line | N5340 LORAINE DR
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City | FREDONIA
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State | WI
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Zip | 53021-9765
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Country | US
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Telephone | 262-692-3715
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2972
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13237
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4063
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License Number State | ND
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10884
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10884
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License Number State | WI
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