Ida Osathanugrah

NPI #1205558707 in Clovis, California

Provider Information

NPI Number: 1205558707
Entity Type: Individual
Name: Ida Osathanugrah
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Enumeration Date: Sep 13, 2022
Last Updated: Sep 13, 2022

Practice Location

Address: 2010 LOS ALTOS AVE
City: Clovis
State: California
ZIP Code: 93611-5309
Phone: (661) 557-3800

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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