Provider Demographics
NPI:1790178788
Name:OSACHY, BRUCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:OSACHY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10652 DABNEY DR APT 138
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-7621
Mailing Address - Country:US
Mailing Address - Phone:818-428-8815
Mailing Address - Fax:
Practice Address - Street 1:10652 DABNEY DR APT 138
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-7621
Practice Address - Country:US
Practice Address - Phone:818-428-8815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH45628183500000X
NV11847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist