Provider Demographics
NPI:1235442161
Name:KOSTRIC, ANNA L (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:KOSTRIC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 BANK ST APT 107D
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2578
Mailing Address - Country:US
Mailing Address - Phone:540-250-2001
Mailing Address - Fax:
Practice Address - Street 1:835 GLENROCK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3767
Practice Address - Country:US
Practice Address - Phone:540-250-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist