Provider Demographics
NPI:1184320012
Name:OSTORGA DIAZ, BARRY JOSEF (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JOSEF
Last Name:OSTORGA DIAZ
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 1:1 MEDICAL CENTER DRIVE HC63 BOX 9000
Mailing Address - Street 2:
Mailing Address - City:DILKON
Mailing Address - State:AZ
Mailing Address - Zip Code:86047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3634 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3033
Practice Address - Country:US
Practice Address - Phone:800-628-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH200004603183500000X
NV23702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist