Provider Demographics
NPI:1023366713
Name:OSBORN, STEFEN RAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEFEN
Middle Name:RAY
Last Name:OSBORN
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 1:82N 100E
Mailing Address - Street 2:PO BOX 642
Mailing Address - City:COALVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84017
Mailing Address - Country:US
Mailing Address - Phone:801-599-9161
Mailing Address - Fax:
Practice Address - Street 1:1171 W 2000 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1638
Practice Address - Country:US
Practice Address - Phone:801-599-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6888375-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist