Provider Demographics
NPI:1922309657
Name:OSBURN, BENJAMIN MARK (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:MARK
Last Name:OSBURN
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 1:535 W EVERGREEN AVE
Mailing Address - Street 2:PIONEER SQUARE #14
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6534
Mailing Address - Country:US
Mailing Address - Phone:907-761-1460
Mailing Address - Fax:907-761-1419
Practice Address - Street 1:535 W EVERGREEN AVE
Practice Address - Street 2:PIONEER SQUARE #14
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6534
Practice Address - Country:US
Practice Address - Phone:907-761-1460
Practice Address - Fax:907-761-1419
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist