Healthcare Provider Details

I. General information

NPI: 1649273863
Provider Name (Legal Business Name): GARY GILBERT KOESTEN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 W. BOYNTON BEACH BLVD, SUITE 1B #397
BOYNTON BEACH FL
33426
US

IV. Provider business mailing address

1313 W. BOYNTON BEACH BLVD., SUITE 1B #397
BOYNTON BEACH FL
33426
US

V. Phone/Fax

Practice location:
  • Phone: 754-264-2027
  • Fax: 561-739-6094
Mailing address:
  • Phone: 754-264-2027
  • Fax: 561-739-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 23697
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS23697
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: