Provider Demographics
NPI:1881882801
Name:COSTA, VINCENT L (RPH)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:L
Last Name:COSTA
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 1:516 HUMMEL AVE
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1826
Mailing Address - Country:US
Mailing Address - Phone:717-350-1791
Mailing Address - Fax:717-540-5663
Practice Address - Street 1:6007 ALLENTOWN BLVD
Practice Address - Street 2:C/O CVS
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112
Practice Address - Country:US
Practice Address - Phone:717-540-5893
Practice Address - Fax:717-540-5663
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029979L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP029979LOtherPHARMACY LICENSE