Healthcare Provider Details

I. General information

NPI: 1083931117
Provider Name (Legal Business Name): STEPHANIE C O'BRIEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 W CORPORATE LAKES BLVD SUITE 600
WESTON FL
33331-3663
US

IV. Provider business mailing address

10864 TEA OLIVE LN
BOCA RATON FL
33498-4845
US

V. Phone/Fax

Practice location:
  • Phone: 954-660-5555
  • Fax: 954-660-5643
Mailing address:
  • Phone: 561-470-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS39008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: