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Individual

SAMUEL MARION COSTELLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
REG PHARMACIST

Contact information

Practice address
2422 DANVILLE RD SW STE J, DECATUR, AL 35603-4221
(256) 353-1121
(256) 353-1790
Mailing address
4405 AUTUMN LEAVES TRL SE, DECATUR, AL 35603-5340
(125) 635-3633
(256) 353-1790

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7105
AL

Other

Enumeration date
01/17/2007
Last updated
07/08/2007
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