Provider Demographics
NPI:1689927113
Name:GOSZ, GEORGE PAUL (RPH)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PAUL
Last Name:GOSZ
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 1:319 E GREENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2133
Mailing Address - Country:US
Mailing Address - Phone:920-540-4506
Mailing Address - Fax:
Practice Address - Street 1:319 E GREENFIELD ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2133
Practice Address - Country:US
Practice Address - Phone:920-540-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9908-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist