MEDICARE: DR. EASTON CHARLES OSBORNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	032496	AL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RX032496	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2563285543	OTHER		PHONE NUMBER

General Provider Information

NPI Number	:	1184220550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EASTON CHARLES OSBORNE

Provider Business Mailing Address
First Line	:	4315 GOLF CLUB DR
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-5836
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3127 MACON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-1734
Country	:	US
Telephone Number	:	706-563-4502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	12/09/2020

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Directions to “ DR. EASTON CHARLES OSBORNE ” Practice Location

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