Provider Demographics
NPI:1225639222
Name:OSMAN, SCOTT BENJAMIN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:BENJAMIN
Last Name:OSMAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6924 MULDERSTRAAT
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8428
Mailing Address - Country:US
Mailing Address - Phone:517-303-5461
Mailing Address - Fax:
Practice Address - Street 1:1680 PACKARD HWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-9717
Practice Address - Country:US
Practice Address - Phone:517-543-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist