Provider Demographics
NPI:1710276704
Name:OSHAUGHNESSY, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:OSHAUGHNESSY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ESCALON
Mailing Address - State:CA
Mailing Address - Zip Code:95320-2051
Mailing Address - Country:US
Mailing Address - Phone:209-838-3524
Mailing Address - Fax:209-838-6855
Practice Address - Street 1:2135 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320-2051
Practice Address - Country:US
Practice Address - Phone:209-838-3524
Practice Address - Fax:209-838-6855
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist