Healthcare Provider Details

I. General information

NPI: 1083225148
Provider Name (Legal Business Name): BURGANDY LEIGH OESTREICH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 WOODMAN DR
DAYTON OH
45431-1423
US

IV. Provider business mailing address

6220 HARBOUR POINTE UNIT 201
COLUMBUS OH
43231-7705
US

V. Phone/Fax

Practice location:
  • Phone: 937-256-1901
  • Fax:
Mailing address:
  • Phone: 419-230-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03439648
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: