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General NPI Number Information
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NPI Number | 1548550445
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Entity Type | Individual
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Provider Name | WILL OSTUW PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 14 SAMMY MCGHEE BLVD SUITE 104
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City | JASPER
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State | GA
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Zip | 30143-7721
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Country | US
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Telephone | 770-548-2350
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Fax |
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Provider Business Mailing Address
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Address Line | 649 AMAKANADA RD SE
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City | CALHOUN
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State | GA
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Zip | 30701-4621
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Country | US
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Telephone | 770-548-2350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH024860
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License Number State | GA
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