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General NPI Number Information
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NPI Number | 1316053622
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Entity Type | Organization
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Legal Business Name | KOZAK INC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1208 CLOQUET AVE
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City | CLOQUET
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State | MN
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Zip | 55720-1622
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Country | US
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Telephone | 218-879-4547
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Fax | 218-878-1804
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Provider Business Mailing Address
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Address Line | 1208 CLOQUET AVE
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City | CLOQUET
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State | MN
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Zip | 55720-1622
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | JOHN GUST
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Credential | RPH
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Telephone | 218-879-4547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 261341
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 261341
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License Number State | MN
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