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General NPI Number Information
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NPI Number | 1659140929
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Entity Type | Individual
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Provider Name | KIRSTEN ROSE COSTALES TEOTICO PHARMD, RPH
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Gender | Female
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 2300 16TH ST UNIT 203
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-4805
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Country | US
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Telephone | 415-575-1130
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Fax |
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Provider Business Mailing Address
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Address Line | 128 NURSERY WAY
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-3290
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Country | US
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Telephone | 650-871-7821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 89148
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License Number State | CA
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