Provider Demographics
NPI:1184939746
Name:DOSTAL, JOHN L (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:DOSTAL
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 1:259 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04281-1620
Mailing Address - Country:US
Mailing Address - Phone:207-743-5177
Mailing Address - Fax:
Practice Address - Street 1:259 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281-1620
Practice Address - Country:US
Practice Address - Phone:207-743-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-07
Last Update Date:2010-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist