Provider Demographics
NPI:1003574963
Name:OSWALD, JERRY DON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:DON
Last Name:OSWALD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3753
Mailing Address - Country:US
Mailing Address - Phone:714-731-1344
Mailing Address - Fax:714-731-7363
Practice Address - Street 1:13400 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3753
Practice Address - Country:US
Practice Address - Phone:714-731-1344
Practice Address - Fax:714-731-7363
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist