Basic Information
| Provider Information | |||||||||
| NPI: | 1184226060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSCA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | TERESA | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1637 WYND CREST WAY | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234561484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574711845 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4821 VIRGINIA BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234626710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572782011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2020 | ||||||||
| LastUpdateDate: | 11/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 0202012563 | VA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.