Provider Demographics
NPI:1710293410
Name:KOESTER, KERMIT L (RPH)
Entity Type:Individual
Prefix:
First Name:KERMIT
Middle Name:L
Last Name:KOESTER
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 1:5601 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1986
Mailing Address - Country:US
Mailing Address - Phone:210-647-2710
Mailing Address - Fax:
Practice Address - Street 1:1726 EAGLE MDW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1301
Practice Address - Country:US
Practice Address - Phone:210-479-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist