Provider Demographics
NPI:1447391040
Name:OSBORNE PHARM II INC
Entity Type:Organization
Organization Name:OSBORNE PHARM II INC
Other - Org Name:MEDICAL PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-474-3887
Mailing Address - Street 1:201 NW 82ND AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7808
Mailing Address - Country:US
Mailing Address - Phone:954-474-3887
Mailing Address - Fax:954-475-3180
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:STE 101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7808
Practice Address - Country:US
Practice Address - Phone:954-474-3887
Practice Address - Fax:954-475-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH259153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000974100Medicaid
2132898OtherPK