MEDICARE: DR. CASSIE MARIE KOKOSZKA PHARMD

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	20344	OK
2	183500000X	Pharmacist	0202221189	VA
3	183500000X	Pharmacist	PD16524	AR
4	183500000X	Pharmacist	24443	NC
5	183500000X	Pharmacist	42745	TN

General Provider Information

NPI Number	:	1588072060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASSIE MARIE KOKOSZKA PHARMD

Provider Business Mailing Address
First Line	:	9526 APISON PIKE STE 100
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-9578
Country	:	US
Telephone Number	:	423-615-6004
Fax Number	:

Provider Business Practice Location Address
First Line	:	9526 APISON PIKE STE 100
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-9578
Country	:	US
Telephone Number	:	423-615-6004
Fax Number	:

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	01/14/2026

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