MEDICARE: DANIEL WILLIAM KOSKI R.PH.

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	1136601	MN

General Provider Information

NPI Number	:	1508856527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL WILLIAM KOSKI R.PH.

Provider Business Mailing Address
First Line	:	750 MAIN ST
Second Line	:	SUITE 103
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55118-3764
Country	:	US
Telephone Number	:	651-455-6873
Fax Number	:	651-451-7997

Provider Business Practice Location Address
First Line	:	750 MAIN ST
Second Line	:	SUITE 103
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55118-3764
Country	:	US
Telephone Number	:	651-455-6873
Fax Number	:	651-451-7997

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	12/08/2010

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