Provider Demographics
NPI:1558760710
Name:SOOST, CHARLES (R PH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:SOOST
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 E DANIA BEACH BLVD
Mailing Address - Street 2:#451
Mailing Address - City:DANIA
Mailing Address - State:FL
Mailing Address - Zip Code:33004-3051
Mailing Address - Country:US
Mailing Address - Phone:407-383-3817
Mailing Address - Fax:
Practice Address - Street 1:398 E DANIA BEACH BLVD
Practice Address - Street 2:#451
Practice Address - City:DANIA
Practice Address - State:FL
Practice Address - Zip Code:33004-3051
Practice Address - Country:US
Practice Address - Phone:407-383-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 15254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist