Provider Demographics
NPI:1366756850
Name:KOBASA, ZENON P (RPH)
Entity type:Individual
Prefix:MR
First Name:ZENON
Middle Name:P
Last Name:KOBASA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODSTOWN DARETOWN RD
Mailing Address - Street 2:
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-2712
Mailing Address - Country:US
Mailing Address - Phone:856-358-0315
Mailing Address - Fax:
Practice Address - Street 1:865 ROUTE 45
Practice Address - Street 2:RITE AID 10469
Practice Address - City:PILESGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08098-2819
Practice Address - Country:US
Practice Address - Phone:856-769-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01473400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist