Basic Information
| Provider Information | |||||||||
| NPI: | 1952553000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BJURSTROM | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 105109 | ||||||||
| Address2: | WEED ARMY COMMUNITY HOSPITAL | ||||||||
| City: | APO | ||||||||
| State: | AA | ||||||||
| PostalCode: | 923105109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603803130 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | INNER LOOP BLDG 170 | ||||||||
| Address2: | MARY WALKER CLINIC | ||||||||
| City: | FORT IRWIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923105109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603803130 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 10/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 20756 | IA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.