Provider Demographics
NPI:1649273863
Name:KOESTEN, GARY GILBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:GILBERT
Last Name:KOESTEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1313 W. BOYNTON BEACH BLVD., SUITE 1B
Mailing Address - Street 2:#397
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426
Mailing Address - Country:US
Mailing Address - Phone:754-264-2027
Mailing Address - Fax:561-739-6094
Practice Address - Street 1:1313 W. BOYNTON BEACH BLVD, SUITE 1B
Practice Address - Street 2:#397
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:754-264-2027
Practice Address - Fax:561-739-6094
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 23697183500000X
FLPS23697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist