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General NPI Number Information
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NPI Number | 1508438318
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Entity Type | Individual
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Provider Name | WAYNE NEAL COSTON RPH
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Gender | Male
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 925 CLARKSVILLE ST
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City | PARIS
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State | TX
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Zip | 75460-6073
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Country | US
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Telephone | 903-785-3785
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Fax |
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Provider Business Mailing Address
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Address Line | 6334 FM 195
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City | PARIS
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State | TX
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Zip | 75462
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Country | US
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Telephone | 903-517-2029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 28831
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28831
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License Number State | TX
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