MEDICARE: MARCO KOSTANDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	73470	CA

General Provider Information

NPI Number	:	1134585979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO KOSTANDY

Provider Business Mailing Address
First Line	:	8231 MAUREEN DR
Second Line	:
City	:	MIDWAY CITY
State	:	CA
Zip	:	92655-1613
Country	:	US
Telephone Number	:	714-605-8411
Fax Number	:

Provider Business Practice Location Address
First Line	:	8231 MAUREEN DR
Second Line	:
City	:	MIDWAY CITY
State	:	CA
Zip	:	92655-1613
Country	:	US
Telephone Number	:	714-605-8411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2016
Last Update Date	:	01/09/2016

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Directions to “ MARCO KOSTANDY ” Practice Location

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