Samuel Marion Costello, REG PHARMACIST

Primary specialty

PharmacistTaxonomy code 183500000X

License

7105 Issued in AL

Practice address

2422 Danville Rd SW Ste J
Decatur, AL 35603-4221

Phone

(256) 353-1121

Fax

(256) 353-1790

NPI assigned

Jan 17, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Compouding Inc.

  • Durable Medical Equipment & Medical Supplies
  • Decatur, AL
  • NPI 1619481306
  NPD Authorized official
• Legacy Compounding Inc

  • Compounding Pharmacy
  • Decatur, AL
  • NPI 1144733072
  NPD Authorized official
• Premium Compounding Inc

  • Compounding Pharmacy
  • Decatur, AL
  • NPI 1013408772
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629120894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 AUTUMN LEAVES TRL SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356035340",
            "telephone_number": "125-635-3633",
            "fax_number": "256-353-1790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2422 DANVILLE RD SW STE J",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356034221",
            "telephone_number": "256-353-1121",
            "fax_number": "256-353-1790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "SAMUEL",
        "middle_name": "MARION",
        "credential": "REG PHARMACIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AL",
            "license": "7105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cornerstone Dentistry of Decatur
• Joshua Cornett, DPT
• Genia Elizabeth Corum, CRNA
• Cos Place LLC
• Nicole Eleanor Cosgrove, COTA
• Jonathan Ray Cothren, BS
• Cottages Decatur, LLC
• Michelle Couey, LCSW
• Olivia Coursey, MSW
• Megan Anna Couts, PHARMD

• Pharmacist in Decatur, AL
• Providers in Decatur, AL by specialty
• Pharmacist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.