Provider Demographics
NPI:1659140929
Name:TEOTICO, KIRSTEN ROSE COSTALES (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN ROSE
Middle Name:COSTALES
Last Name:TEOTICO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 NURSERY WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3290
Mailing Address - Country:US
Mailing Address - Phone:650-871-7821
Mailing Address - Fax:
Practice Address - Street 1:2300 16TH ST UNIT 203
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4805
Practice Address - Country:US
Practice Address - Phone:415-575-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist