Provider Demographics
NPI:1487779005
Name:COSTA, STACY LYNN (RPH)
Entity type:Individual
Prefix:MR
First Name:STACY
Middle Name:LYNN
Last Name:COSTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-2601
Mailing Address - Country:US
Mailing Address - Phone:412-401-4242
Mailing Address - Fax:
Practice Address - Street 1:6200 SALTSBURG RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-2066
Practice Address - Country:US
Practice Address - Phone:412-798-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035023R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist