Provider Demographics
NPI:1326550716
Name:KOSTISHAK, PAUL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:KOSTISHAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9058
Mailing Address - Country:US
Mailing Address - Phone:717-877-8946
Mailing Address - Fax:
Practice Address - Street 1:2702 CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9058
Practice Address - Country:US
Practice Address - Phone:717-877-8946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist