Provider Demographics
NPI:1952722100
Name:OSBORN, JOHN BURNHAM (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BURNHAM
Last Name:OSBORN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1183
Mailing Address - Country:US
Mailing Address - Phone:253-752-9110
Mailing Address - Fax:253-756-9320
Practice Address - Street 1:4505 S 19TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1183
Practice Address - Country:US
Practice Address - Phone:253-752-9110
Practice Address - Fax:253-756-9320
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPL00009951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist