Provider Demographics
NPI:1184900086
Name:BOSIRE-HORGAN, PRISCA KERUBO (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:
First Name:PRISCA
Middle Name:KERUBO
Last Name:BOSIRE-HORGAN
Suffix:
Gender:F
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:PRISCA
Other - Middle Name:KERUBO
Other - Last Name:BOSIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED PHARMACIS
Mailing Address - Street 1:3993 W MAIN ST
Mailing Address - Street 2:#8
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5679
Mailing Address - Country:US
Mailing Address - Phone:360-721-1342
Mailing Address - Fax:
Practice Address - Street 1:2125 W US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552-5446
Practice Address - Country:US
Practice Address - Phone:928-428-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist