Provider Demographics
NPI:1861809519
Name:OSWALD, CHRISTINE DIANE (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DIANE
Last Name:OSWALD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:OSWALD
Other - Last Name:KOECHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1685 RADIO HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233
Mailing Address - Country:US
Mailing Address - Phone:314-749-1797
Mailing Address - Fax:573-893-5176
Practice Address - Street 1:2805 W TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-0545
Practice Address - Country:US
Practice Address - Phone:573-893-2226
Practice Address - Fax:573-893-5176
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist