Justin M Costa

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH05959 Issued in RI

Practice address

677 Main Rd
Tiverton, RI 02878-1352

Phone

(401) 624-8411

NPI assigned

Dec 4, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1543881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543881600000",
    "number": "1992275754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 BROWNELL ST APT 3",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027202717",
            "telephone_number": "508-410-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 MAIN RD",
            "city": "TIVERTON",
            "state": "RI",
            "postal_code": "028781352",
            "telephone_number": "401-624-8411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTA",
        "first_name": "JUSTIN",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-04",
        "last_updated": "2018-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MA",
            "license": "PH238590",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "RI",
            "license": "RPH05959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA BOARD OF PHARMACY",
            "identifier": "PH238590",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RI BOARD OF PHARMACY",
            "identifier": "RPH05959",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachael Christine Cavallaro, BFA, MSW
• Louis Anthony Cerbo, ED.D.
• Virginia M Cerbo, LICSW
• Sara Elizabeth Charnecki, MD
• Jessica Brooke Chaves, P.T.
• Norman A Cote, DDS
• Melissa Cotta
• Adam J Cox, PHD
• Tracy Ann Dagesse, MSW, LICSW
• Anne Davidge, PHD

• All providers in Tiverton, RI
• Pharmacist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2018; 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.