Gordana Kostich, RPH
Individual provider Active NPI Pharmacist · Lyons, IL
NPI 1770865610 · NPPES record last updated Sep 16, 2011
Key facts
- NPI
- 1770865610
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051037805 (IL)
- Practice address
- 4101 1St Ave
Lyons, IL 60534-1028 - Phone
- (708) 447-6851
- Fax
- (708) 447-0568
- NPI assigned
- Sep 16, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051037805 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051037805 | IL | Yes |
Addresses
Primary practice location
4101 1St Ave
Lyons, IL 60534-1028
Mailing address
605 Nelson LN
Westmont, IL 60559-2893
Phone (630) 829-4081
Other providers in Lyons, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2011. 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.