MEDICARE: IRENE OSBORN 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	1835C0206X	Cardiology Pharmacist	8334563-1701	UT

General Provider Information

NPI Number	:	1639864507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE OSBORN PHARMD

Provider Business Mailing Address
First Line	:	50 N MEDICAL DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 N MEDICAL DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0001
Country	:	US
Telephone Number	:	801-706-6796
Fax Number	:

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

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/06/2023

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