Provider Demographics
NPI:1306342332
Name:OSBORN, GREGORY LEE (RPH)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
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 1:2506 LAKELAND DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7656
Mailing Address - Country:US
Mailing Address - Phone:601-420-4041
Mailing Address - Fax:601-420-4040
Practice Address - Street 1:2506 LAKELAND DR STE 201
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7656
Practice Address - Country:US
Practice Address - Phone:601-420-4041
Practice Address - Fax:601-420-4040
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD7437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist