Provider Demographics
NPI:1477851327
Name:HIMSTEDT, GARY F (RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:F
Last Name:HIMSTEDT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8938
Mailing Address - Country:US
Mailing Address - Phone:843-750-0032
Mailing Address - Fax:
Practice Address - Street 1:2872 HIGHWAY 17 SOUTH
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-357-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12105183500000X
IL051.029179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist