Healthcare Provider Details

I. General information

NPI: 1932103686
Provider Name (Legal Business Name): GEORGE LOUIS OESTREICH PHARM.D., MPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3714 TAYLORS RIDGE CT
JEFFERSON CITY MO
65109-5882
US

IV. Provider business mailing address

3714 TAYLORS RIDGE CT
JEFFERSON CITY MO
65109-5882
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-2411
  • Fax: 573-632-2411
Mailing address:
  • Phone: 573-636-7075
  • Fax: 573-632-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28085
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: