Provider Demographics
NPI:1699229948
Name:OSHTEMO PHARMACY LLC
Entity Type:Organization
Organization Name:OSHTEMO PHARMACY LLC
Other - Org Name:OSHTEMO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:734-658-1192
Mailing Address - Street 1:635 N 9TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5897
Mailing Address - Country:US
Mailing Address - Phone:269-459-8653
Mailing Address - Fax:269-459-8654
Practice Address - Street 1:635 N 9TH ST STE E
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5897
Practice Address - Country:US
Practice Address - Phone:269-459-8653
Practice Address - Fax:269-459-8654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301010987333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162465OtherPK