MEDICARE: DR. MARYLOU KOSMATKA PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	2210	NH

General Provider Information

NPI Number	:	1912905274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYLOU KOSMATKA PHARM.D.

Provider Business Mailing Address
First Line	:	46 WHEELER RD
Second Line	:
City	:	HOLLIS
State	:	NH
Zip	:	03049-5926
Country	:	US
Telephone Number	:	603-465-2010
Fax Number	:	603-465-6591

Provider Business Practice Location Address
First Line	:	1 ELLIOT WAY
Second Line	:	ELLIOT HOSPITAL PHARMACY
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3502
Country	:	US
Telephone Number	:	603-663-2404
Fax Number	:	603-663-3987

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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