Individual
LARRY PATRICK COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4668 N SHORE DR, CLEAR LAKE, IA 50428-1275
(641) 529-0820
(877) 814-4512
Mailing address
1907 US HIGHWAY 18 E, CLEAR LAKE, IA 50428-2004
(641) 357-5271
(877) 814-4512
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13166
IA
Other
Enumeration date
06/04/2021
Last updated
06/04/2021
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