Healthcare Provider Details

I. General information

NPI: 1871180646
Provider Name (Legal Business Name): JEAN OSBORN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 BROOKLYN RD
BROOKLYN MI
49230-8485
US

IV. Provider business mailing address

8577 IRISH MIST
ONSTED MI
49265-9309
US

V. Phone/Fax

Practice location:
  • Phone: 517-592-2475
  • Fax:
Mailing address:
  • Phone: 517-605-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5302021642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: