Healthcare Provider Details

I. General information

NPI: 1508421546
Provider Name (Legal Business Name): CARINA OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 CANYON DR
PINOLE CA
94564-2151
US

IV. Provider business mailing address

1141 GRIZZLY PEAK BLVD
BERKELEY CA
94708-1739
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-8880
  • Fax:
Mailing address:
  • Phone: 510-508-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: