1154361426 NPI number — VICTORIA KOSTIS BS PHARMACY

Table of content: VICTORIA KOSTIS BS PHARMACY (NPI 1154361426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154361426 NPI number — VICTORIA KOSTIS BS PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSTIS
Provider First Name:
VICTORIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS PHARMACY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154361426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/13/2009
NPI Reactivation Date:
05/11/2010

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1858 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANGHORNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19047-1728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-702-8929
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 PRINCETON-HIGHSTOWN RD
Provider Second Line Business Practice Location Address:
TARGET PHARMACY
Provider Business Practice Location Address City Name:
EAST WINDSOR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-371-2362
Provider Business Practice Location Address Fax Number:
609-371-2362
Provider Enumeration Date:
06/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RI24884 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: RP439154 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)