Provider Demographics
NPI:1407260573
Name:OSBOURN, KAYLA MCCOLLUM (PHARM D)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MCCOLLUM
Last Name:OSBOURN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W FORT WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2430
Mailing Address - Country:US
Mailing Address - Phone:256-249-8646
Mailing Address - Fax:
Practice Address - Street 1:100 W FORT WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2430
Practice Address - Country:US
Practice Address - Phone:256-249-8646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist