Provider Demographics
NPI:1548550445
Name:OSTUW, WILL (PHARMD)
Entity type:Individual
Prefix:
First Name:WILL
Middle Name:
Last Name:OSTUW
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 1:649 AMAKANADA RD SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-4621
Mailing Address - Country:US
Mailing Address - Phone:770-548-2350
Mailing Address - Fax:
Practice Address - Street 1:14 SAMMY MCGHEE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-7721
Practice Address - Country:US
Practice Address - Phone:770-548-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist