Provider Demographics
NPI:1932103686
Name:OESTREICH, GEORGE LOUIS (PHARMD, MPA)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LOUIS
Last Name:OESTREICH
Suffix:
Gender:M
Credentials:PHARMD, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 TAYLORS RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5882
Mailing Address - Country:US
Mailing Address - Phone:573-636-7075
Mailing Address - Fax:573-632-2411
Practice Address - Street 1:3714 TAYLORS RIDGE CT
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5882
Practice Address - Country:US
Practice Address - Phone:573-642-2411
Practice Address - Fax:573-632-2411
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist