Basic Information
| Provider Information | |||||||||
| NPI: | 1861809519 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSWALD | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOECHNER | ||||||||
| OtherFirstName: | CHRISTINE | ||||||||
| OtherMiddleName: | OSWALD | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1685 RADIO HILL ROAD | ||||||||
| Address2: | |||||||||
| City: | BOONVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147491797 | ||||||||
| FaxNumber: | 5738935176 | ||||||||
| Practice Location | |||||||||
| Address1: | 2805 W TRUMAN BLVD | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651090545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738932226 | ||||||||
| FaxNumber: | 5738935176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2014 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 040581 | MO | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.