Provider Demographics
NPI:1154361426
Name:KOSTIS, VICTORIA (BS PHARMACY)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:KOSTIS
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1728
Mailing Address - Country:US
Mailing Address - Phone:215-702-8929
Mailing Address - Fax:
Practice Address - Street 1:70 PRINCETON-HIGHSTOWN RD
Practice Address - Street 2:TARGET PHARMACY
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520
Practice Address - Country:US
Practice Address - Phone:609-371-2362
Practice Address - Fax:609-371-2362
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-05-11
Deactivation Date:2009-01-13
Deactivation Code:
Reactivation Date:2010-05-11
Provider Licenses
StateLicense IDTaxonomies
NJRI24884183500000X
PARP439154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist