Provider Demographics
NPI:1356689681
Name:CALABRIA-COSTANZO, MICHELE ANN
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANN
Last Name:CALABRIA-COSTANZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ANN
Other - Last Name:CALABRIA-COSTANZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:15265 COLLIER BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-7715
Mailing Address - Country:US
Mailing Address - Phone:239-348-9759
Mailing Address - Fax:239-348-0665
Practice Address - Street 1:15265 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-7715
Practice Address - Country:US
Practice Address - Phone:239-348-9759
Practice Address - Fax:239-348-0665
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist