Provider Demographics
NPI:1336849181
Name:COSTON, WILLIAM EUGENE JR (CPHT3)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:COSTON
Suffix:JR
Gender:M
Credentials:CPHT3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1383
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34958-1383
Mailing Address - Country:US
Mailing Address - Phone:772-288-6541
Mailing Address - Fax:772-288-6543
Practice Address - Street 1:4001 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4909
Practice Address - Country:US
Practice Address - Phone:772-288-6541
Practice Address - Fax:772-288-6543
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT4297183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRPT4297OtherFLORIDA BOARD OF PHARMACY
FLA4E6P2C6OtherNHA