Provider Demographics
NPI:1548585250
Name:ENRIQUEZ, OSVALDO JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:OSVALDO
Middle Name:
Last Name:ENRIQUEZ
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:300 N MORLEY
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-0957
Mailing Address - Country:US
Mailing Address - Phone:660-263-0909
Mailing Address - Fax:660-263-2124
Practice Address - Street 1:300 N MORLEY
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-0957
Practice Address - Country:US
Practice Address - Phone:660-263-0909
Practice Address - Fax:660-263-2124
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist