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Individual

JUSTIN M COSTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
677 MAIN RD, TIVERTON, RI 02878-1352
(401) 624-8411
Mailing address
195 BROWNELL ST APT 3, FALL RIVER, MA 02720-2717
(508) 410-1451

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
PH238590
MA
183500000X
Pharmacist
Primary
RPH05959
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PH238590
MA BOARD OF PHARMACY
MA
01
RPH05959
RI BOARD OF PHARMACY
RI
Enumeration date
12/04/2018
Last updated
12/04/2018
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