MEDICARE: MR. JONAS KOSIK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP030111L	PA

General Provider Information

NPI Number	:	1043218175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONAS KOSIK

Provider Business Mailing Address
First Line	:	3900 FORD RD
Second Line	:	APT 22-J
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 CONSHOHOCKEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-5430
Country	:	US
Telephone Number	:	215-879-2520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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