Provider Demographics
NPI:1861589202
Name:COSTANZA, JOHN JOSEPH (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:COSTANZA
Suffix:
Gender:M
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 205
Mailing Address - Street 2:302 BUSHLEY STREET
Mailing Address - City:HARRISONBURG
Mailing Address - State:LA
Mailing Address - Zip Code:71340
Mailing Address - Country:US
Mailing Address - Phone:318-744-5351
Mailing Address - Fax:318-744-5368
Practice Address - Street 1:BOX 205
Practice Address - Street 2:302 BUSHLEY STREET
Practice Address - City:HARRISONBURG
Practice Address - State:LA
Practice Address - Zip Code:71340
Practice Address - Country:US
Practice Address - Phone:318-744-5351
Practice Address - Fax:318-744-5368
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist