MEDICARE: CHRISTINA SUSAN OISTEN R.PH.

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	183500000X	Pharmacist	5302026001	MI

General Provider Information

NPI Number	:	1962530030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA SUSAN OISTEN R.PH.

Provider Business Mailing Address
First Line	:	1561 WOODHILL CT SW
Second Line	:
City	:	WYOMING
State	:	MI
Zip	:	49509-5041
Country	:	US
Telephone Number	:	616-249-9795
Fax Number	:	616-406-0158

Provider Business Practice Location Address
First Line	:	4410 DIVISION AVE S
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49548-4305
Country	:	US
Telephone Number	:	616-532-9241
Fax Number	:	616-406-0158

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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