Provider Demographics
NPI:1689083198
Name:GOLSTON, DANTE RAMON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANTE
Middle Name:RAMON
Last Name:GOLSTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 SHERWOOD LAKE DR
Mailing Address - Street 2:APARTMENT 2B
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2794
Mailing Address - Country:US
Mailing Address - Phone:219-742-4472
Mailing Address - Fax:
Practice Address - Street 1:3500 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAKE STATION
Practice Address - State:IN
Practice Address - Zip Code:46405-2271
Practice Address - Country:US
Practice Address - Phone:219-963-7355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025739A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist