Kelly Marie Costello
Individual provider Active NPI Pharmacist · East Chicago, IN
NPI 1194237495 · NPPES record last updated Dec 17, 2022
Key facts
- NPI
- 1194237495
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051300725 (IL)
- Practice address
- 2123 E Columbus Dr
East Chicago, IN 46312-2831 - Phone
- (219) 397-6911
- NPI assigned
- Oct 26, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051300725 | IL | MD | Pharmacist |
| 26029134A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26029134A | IN | |
| Pharmacist | 183500000X | 051300725 | IL | Yes |
Addresses
Primary practice location
2123 E Columbus Dr
East Chicago, IN 46312-2831
Mailing address
2123 E Columbus Dr
East Chicago, IN 46312-2831
Phone (219) 397-6911
Other providers in East Chicago, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.