Provider Demographics
NPI:1952553000
Name:BJURSTROM, MARY SUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:BJURSTROM
Suffix:
Gender:F
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:P.O. BOX 105109
Mailing Address - Street 2:WEED ARMY COMMUNITY HOSPITAL
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:92310-5109
Mailing Address - Country:US
Mailing Address - Phone:760-380-3130
Mailing Address - Fax:
Practice Address - Street 1:INNER LOOP BLDG 170
Practice Address - Street 2:MARY WALKER CLINIC
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5109
Practice Address - Country:US
Practice Address - Phone:760-380-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist