Provider Demographics
NPI:1366884314
Name:KOSTOFF, DIANA (BSPHARM, PHARMD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:KOSTOFF
Suffix:
Gender:F
Credentials:BSPHARM, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-8949
Mailing Address - Fax:313-916-2312
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:HENRY FORD HOSPITAL K-13 HEM/ONC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-8949
Practice Address - Fax:313-916-2312
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020303491835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology