Active NPI
Tracy Jean Costello, PHARMD
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Indianapolis, IN
National Provider Identifier
1922742717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 26022763A
- Practice address
- 1500 N Ritter Ave
Indianapolis, IN 46219-3027 - Phone
- (317) 355-2810
- NPI assigned
- Apr 26, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 26022763A | IN | Primary |
Addresses
Primary practice location
1500 N Ritter Ave
Indianapolis, IN 46219-3027
Mailing address
4600 Sunset Ave
Indianapolis, IN 46208-3443
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26022763A | IN | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650931200000",
"number": "1922742717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4600 SUNSET AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462083443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 N RITTER AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462193027",
"telephone_number": "317-355-2810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTELLO",
"first_name": "TRACY",
"middle_name": "JEAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-26",
"last_updated": "2022-04-26",
"certification_date": "2022-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "IN",
"license": "26022763A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.