Individual
KELLY MARIE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2123 E COLUMBUS DR, EAST CHICAGO, IN 46312-2831
(219) 397-6911
Mailing address
2123 E COLUMBUS DR, EAST CHICAGO, IN 46312-2831
(219) 397-6911
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051300725
IL
183500000X
Pharmacist
26029134A
IN
Other
Enumeration date
10/26/2017
Last updated
12/17/2022
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