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NPI Code Detail

MEDICARE: DR. NICOLE MARIE KOSTELC PHARMD

MEDICARE: DR. NICOLE MARIE KOSTELC PHARMD
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
11835G0303XGeriatric Pharmacist51286199IL

General Provider Information

NPI Number : 1821219619
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICOLE MARIE KOSTELC PHARMD
Provider Business Mailing Address
First Line : 8400 WILLOW WEST DR
Second Line :
City : WILLOW SPRINGS
State : IL
Zip : 60480-1140
Country : US
Telephone Number : 708-839-8990
Fax Number :
Provider Business Practice Location Address
First Line : 8400 WILLOW WEST DR
Second Line :
City : WILLOW SPRINGS
State : IL
Zip : 60480-1140
Country : US
Telephone Number : 708-839-8990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/08/2007

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