Individual
CARLY GOSTANIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3862 RIVER RD N, KEIZER, OR 97303-4866
(503) 371-6717
Mailing address
4010 NW WITHAM HILL DR APT 123, CORVALLIS, OR 97330-1648
(559) 280-4063
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PI-0012993
OR
Other
Enumeration date
07/07/2018
Last updated
07/07/2018
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