Provider Demographics
NPI:1407832017
Name:KOSTOVICH, JOHN S (BPHARM, MBA, RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:KOSTOVICH
Suffix:
Gender:M
Credentials:BPHARM, MBA, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11602 TWIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-1322
Mailing Address - Country:US
Mailing Address - Phone:708-478-4618
Mailing Address - Fax:708-478-5267
Practice Address - Street 1:7960 W 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5038
Practice Address - Country:US
Practice Address - Phone:708-532-7781
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist