Provider Demographics
NPI:1073698783
Name:CIRCOSTA, JAMES GEORGE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GEORGE
Last Name:CIRCOSTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62127 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-9559
Mailing Address - Country:US
Mailing Address - Phone:740-425-1352
Mailing Address - Fax:740-425-1795
Practice Address - Street 1:148 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1004
Practice Address - Country:US
Practice Address - Phone:740-425-1582
Practice Address - Fax:740-425-1795
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-08470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0881701Medicaid
OH0599340001Medicare ID - Type Unspecified