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NPI Code Detail

MEDICARE: NICOLE RENEE KOTASKA

MEDICARE: NICOLE RENEE KOTASKA
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
1183500000XPharmacist36878TX

General Provider Information

NPI Number : 1730789967
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE RENEE KOTASKA
Provider Business Mailing Address
First Line : 5903 WESSEX CT
Second Line :
City : PARKER
State : TX
Zip : 75002-5455
Country : US
Telephone Number : 214-563-5230
Fax Number :
Provider Business Practice Location Address
First Line : 2662 W LUCAS RD
Second Line :
City : LUCAS
State : TX
Zip : 75002-7513
Country : US
Telephone Number : 469-675-8110
Fax Number : 469-675-8528
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2020
Last Update Date : 10/27/2020

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Directions to “ NICOLE RENEE KOTASKA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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