Provider Demographics
NPI:1336987502
Name:OSINGA, JONATHAN PETER (PHARMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PETER
Last Name:OSINGA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5997 S POINTE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3272
Mailing Address - Country:US
Mailing Address - Phone:239-415-1610
Mailing Address - Fax:239-415-1652
Practice Address - Street 1:5997 S POINTE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3272
Practice Address - Country:US
Practice Address - Phone:239-415-1610
Practice Address - Fax:239-415-1652
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist