Provider Demographics
NPI:1194493692
Name:GERUGHTY, OSHIN VANDANA
Entity type:Individual
Prefix:DR
First Name:OSHIN
Middle Name:VANDANA
Last Name:GERUGHTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 OBSERVATION CIR UNIT 204
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1671
Mailing Address - Country:US
Mailing Address - Phone:502-759-9846
Mailing Address - Fax:
Practice Address - Street 1:13807 ENGLISH VILLA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-3994
Practice Address - Country:US
Practice Address - Phone:502-254-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist