MEDICARE: DR. BARRY JOSEF OSTORGA DIAZ PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH200004603	DC
2	183500000X	Pharmacist	23702	NV

General Provider Information

NPI Number	:	1184320012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY JOSEF OSTORGA DIAZ PHARMD

Provider Business Mailing Address
First Line	:	1 MEDICAL CENTER DRIVE HC63 BOX 9000
Second Line	:
City	:	DILKON
State	:	AZ
Zip	:	86047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3634 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3033
Country	:	US
Telephone Number	:	800-628-6965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2023
Last Update Date	:	03/14/2024

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