Provider Demographics
NPI:1356668453
Name:DAVIDSON, OSLYN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:OSLYN
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3424
Mailing Address - Country:US
Mailing Address - Phone:973-399-0628
Mailing Address - Fax:
Practice Address - Street 1:1084 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2320
Practice Address - Country:US
Practice Address - Phone:973-733-2866
Practice Address - Fax:973-733-9831
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02307700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist