Healthcare Provider Details

I. General information

NPI: 1316877590
Provider Name (Legal Business Name): EDWARD ALBERT COSTRINI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8557 N LILLEY RD
CANTON MI
48187-2091
US

IV. Provider business mailing address

40445 BRECKEN RIDGE LN
PLYMOUTH MI
48170-7613
US

V. Phone/Fax

Practice location:
  • Phone: 734-905-0100
  • Fax:
Mailing address:
  • Phone: 734-730-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302027995
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: