Provider Demographics
NPI:1669580833
Name:VOSTRY, GARY FRANCIS (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:FRANCIS
Last Name:VOSTRY
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:PO BOX 6205
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-6205
Mailing Address - Country:US
Mailing Address - Phone:707-643-0787
Mailing Address - Fax:
Practice Address - Street 1:103 BODIN CIRCLE
Practice Address - Street 2:BUILDING 778
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535
Practice Address - Country:US
Practice Address - Phone:707-437-1820
Practice Address - Fax:707-437-1822
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH24197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist