=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669580833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY FRANCIS VOSTRY RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 BODIN CIRCLE BUILDING 778
-----------------------------------------------------
City | TRAVIS AFB
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-437-1820
-----------------------------------------------------
Fax | 707-437-1822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6205
-----------------------------------------------------
City | VALLEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94591-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-643-0787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH24197
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------