Provider Demographics
NPI:1417364225
Name:KOESTER, KODY
Entity Type:Individual
Prefix:
First Name:KODY
Middle Name:
Last Name:KOESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:KS
Mailing Address - Zip Code:67058-0456
Mailing Address - Country:US
Mailing Address - Phone:620-896-7700
Mailing Address - Fax:
Practice Address - Street 1:615 W 12TH ST
Practice Address - Street 2:
Practice Address - City:HARPER
Practice Address - State:KS
Practice Address - Zip Code:67058-1214
Practice Address - Country:US
Practice Address - Phone:620-896-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist