Provider Demographics
NPI:1982892295
Name:KOSTENBADER, JOYCE L
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:L
Last Name:KOSTENBADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 S CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-5279
Mailing Address - Country:US
Mailing Address - Phone:423-586-0251
Mailing Address - Fax:423-587-9071
Practice Address - Street 1:922 S CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-5279
Practice Address - Country:US
Practice Address - Phone:423-586-0251
Practice Address - Fax:423-587-9071
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist