Provider Demographics
NPI:1154557940
Name:KOSTARIDES, STACEY ELLEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ELLEN
Last Name:KOSTARIDES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3423
Mailing Address - Country:US
Mailing Address - Phone:401-792-7179
Mailing Address - Fax:401-792-7184
Practice Address - Street 1:20 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3423
Practice Address - Country:US
Practice Address - Phone:401-792-7179
Practice Address - Fax:401-792-7184
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH047037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist