Provider Demographics
NPI:1437133246
Name:OSTERBERGER, MARY KATHLEEN (CRPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHLEEN
Last Name:OSTERBERGER
Suffix:
Gender:F
Credentials:CRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 N 46TH AVE
Mailing Address - Street 2:D532
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15712 SW 41ST ST
Practice Address - Street 2:SUITE 16
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-1538
Practice Address - Country:US
Practice Address - Phone:954-217-6055
Practice Address - Fax:954-217-4090
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16426183500000X
FLPU1950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist