Healthcare Provider Details

I. General information

NPI: 1346534823
Provider Name (Legal Business Name): OSMAN MUSSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 HIGHWAY 46
WASCO CA
93280-2919
US

IV. Provider business mailing address

9607 CHEYENNE DR
BAKERSFIELD CA
93312-3997
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-0133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: