MEDICARE: DR. KOSSIVI EBLE 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	26423	MD

General Provider Information

NPI Number	:	1811668395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KOSSIVI EBLE PHARMD

Provider Business Mailing Address
First Line	:	1519 ROCK SPRING RD
Second Line	:
City	:	FOREST HILL
State	:	MD
Zip	:	21050-2833
Country	:	US
Telephone Number	:	410-638-8757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1519 ROCK SPRING RD
Second Line	:
City	:	FOREST HILL
State	:	MD
Zip	:	21050-2833
Country	:	US
Telephone Number	:	410-638-8757
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	09/23/2021

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