Provider Demographics
NPI:1609158278
Name:COSTIGAN, JOHN EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:COSTIGAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MILL ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-1008
Mailing Address - Country:US
Mailing Address - Phone:781-944-3092
Mailing Address - Fax:
Practice Address - Street 1:5 HARNDEN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3001
Practice Address - Country:US
Practice Address - Phone:781-944-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH17537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist