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NPI Code Detail

MEDICARE: LISA LYNN OBRIEN PHARMACIST

MEDICARE: LISA LYNN OBRIEN PHARMACIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist116443MN

General Provider Information

NPI Number : 1538437843
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA LYNN OBRIEN PHARMACIST
Provider Business Mailing Address
First Line : 1648 BROOKS AVE. E
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-2101
Country : US
Telephone Number : 651-779-4368
Fax Number :
Provider Business Practice Location Address
First Line : 2920 WHITE BEAR AVE NORTH
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-1304
Country : US
Telephone Number : 651-251-9938
Fax Number : 651-251-9944
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2011
Last Update Date : 12/01/2011

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