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NPI Code Detail

MEDICARE: MR. BERNARD T. GOSMA RPH.

MEDICARE: MR. BERNARD T. GOSMA RPH.
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
1183500000XPharmacistS11942AZ

General Provider Information

NPI Number : 1326338898
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BERNARD T. GOSMA RPH.
Provider Business Mailing Address
First Line : 4823 S HIGHWAY 95
Second Line :
City : FORT MOHAVE
State : AZ
Zip : 86426-8314
Country : US
Telephone Number : 928-704-4443
Fax Number : 928-704-1684
Provider Business Practice Location Address
First Line : 4823 S HIGHWAY 95
Second Line :
City : FORT MOHAVE
State : AZ
Zip : 86426-8314
Country : US
Telephone Number : 928-704-4443
Fax Number : 928-704-1684
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2011
Last Update Date : 04/18/2011

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