| Doctor Name: | DR. NICOLE MARIE KOSTELC |
| NPI Number: | 1821219619 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHARMD |
| License Number: | 51286199 |
| Business Practice Address: | 8400 Willow West Dr Willow Springs, IL - 604801140 |
| Business Phone Number: | 7088398990 |
| Business Fax Number: | |
| Mailing Address: | 8400 Willow West Dr, WILLOW SPRINGS |
| State: | IL |
| Postal Code: | 604801140 |
| Phone Number: | 7088398990 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835G0303X |
| License Number: | 51286199 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Geriatric |
| Taxonomy Definition: | A pharmacist who is certified in geriatric pharmacy practice is designated as a |