Provider Demographics
NPI:1134447527
Name:KOSTRZEWA, DELNESE M (RPH)
Entity type:Individual
Prefix:MRS
First Name:DELNESE
Middle Name:M
Last Name:KOSTRZEWA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22521 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2122
Mailing Address - Country:US
Mailing Address - Phone:313-278-1515
Mailing Address - Fax:313-792-0934
Practice Address - Street 1:22521 MICHIGAN
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-278-1515
Practice Address - Fax:313-792-0934
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist