Individual
COSTADINA ANEZIRIS COSTIANIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2313 S MOUNT PROSPECT RD, DES PLAINES, IL 60018-1811
(800) 369-6512
Mailing address
3515 KEENAN LN, GLENVIEW, IL 60026-1102
(847) 271-5119
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051296943
IL
Other
Enumeration date
05/28/2021
Last updated
05/28/2021
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