Healthcare Provider Details

I. General information

NPI: 1306342332
Provider Name (Legal Business Name): GREGORY LEE OSBORN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 LAKELAND DR STE 201
FLOWOOD MS
39232-7656
US

IV. Provider business mailing address

2506 LAKELAND DR STE 201
FLOWOOD MS
39232-7656
US

V. Phone/Fax

Practice location:
  • Phone: 601-420-4041
  • Fax: 601-420-4040
Mailing address:
  • Phone: 601-420-4041
  • Fax: 601-420-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberD7437
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: