Provider Demographics
NPI:1770989915
Name:KOESTERER, MARIA (RPH)
Entity type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:
Last Name:KOESTERER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3670
Mailing Address - Country:US
Mailing Address - Phone:618-520-4511
Mailing Address - Fax:
Practice Address - Street 1:515 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3670
Practice Address - Country:US
Practice Address - Phone:618-520-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012041410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist