Healthcare Provider Details

I. General information

NPI: 1861438962
Provider Name (Legal Business Name): OBRYAN COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 ZINFANDEL DR STE 101
RANCHO CORDOVA CA
95670-2862
US

IV. Provider business mailing address

1995 ZINFANDEL DR STE 101
RANCHO CORDOVA CA
95670-2862
US

V. Phone/Fax

Practice location:
  • Phone: 916-631-4440
  • Fax: 916-635-1024
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY47520
License Number StateCA

VIII. Authorized Official

Name: AUBREY OBRYAN
Title or Position: PRESIDENT
Credential:
Phone: 916-852-4222