Provider Demographics
NPI:1275703746
Name:COSTAS, CHARLES (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:COSTAS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2734
Mailing Address - Country:US
Mailing Address - Phone:516-671-1520
Mailing Address - Fax:516-759-7180
Practice Address - Street 1:201 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2734
Practice Address - Country:US
Practice Address - Phone:516-671-1520
Practice Address - Fax:516-759-7180
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist