Individual
MR. ANDY WALTER KOSTECHKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
16100 SW 72ND AVE, PORTLAND, OR 97224-7745
(503) 626-9436
(503) 372-1792
Mailing address
16100 SW 72ND AVE, PORTLAND, OR 97224-7745
(503) 626-9436
(503) 372-1792
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6326
OR
Other
Enumeration date
05/11/2014
Last updated
05/11/2014
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