Provider Demographics
NPI:1588326367
Name:BJERKE, OCEANA S (PHARMD, BCMTMS)
Entity type:Individual
Prefix:
First Name:OCEANA
Middle Name:S
Last Name:BJERKE
Suffix:
Gender:F
Credentials:PHARMD, BCMTMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NORTH JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-9620
Mailing Address - Country:US
Mailing Address - Phone:833-230-2073
Mailing Address - Fax:
Practice Address - Street 1:140 NORTH JEFFERSON
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402
Practice Address - Country:US
Practice Address - Phone:800-123-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-09
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNONEOtherNONE