Provider Demographics
NPI:1124330352
Name:DECOSTER, GERALD R (RPH)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:R
Last Name:DECOSTER
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13744 BREEZY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2809
Mailing Address - Country:US
Mailing Address - Phone:586-247-1214
Mailing Address - Fax:
Practice Address - Street 1:13744 BREEZY DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2809
Practice Address - Country:US
Practice Address - Phone:586-247-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist