Provider Demographics
NPI:1437443579
Name:KOSOSKI, MICHELLE ANNE (RPH)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANNE
Last Name:KOSOSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3770
Mailing Address - Country:US
Mailing Address - Phone:860-741-8054
Mailing Address - Fax:860-741-8054
Practice Address - Street 1:90 ELM ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3770
Practice Address - Country:US
Practice Address - Phone:860-741-8054
Practice Address - Fax:860-741-8054
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT00009248183500000X
FLPS25902183500000X
MAPH24361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist