Provider Demographics
NPI:1134418734
Name:COSTELLO, HELEN (RPH)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-2142
Mailing Address - Country:US
Mailing Address - Phone:413-528-5460
Mailing Address - Fax:413-528-5588
Practice Address - Street 1:700 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2142
Practice Address - Country:US
Practice Address - Phone:413-528-5460
Practice Address - Fax:413-528-5588
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist