Provider Demographics
NPI:1316169451
Name:COSTE, SUSAN M (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:COSTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:COSTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:229 WALSH AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2848
Mailing Address - Country:US
Mailing Address - Phone:860-665-8004
Mailing Address - Fax:
Practice Address - Street 1:229 WALSH AVENUE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2848
Practice Address - Country:US
Practice Address - Phone:860-665-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist