Healthcare Provider Details

I. General information

NPI: 1790801124
Provider Name (Legal Business Name): ROBERT MICHAEL OBRIEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 MEADOW ST
CHICOPEE MA
01013-1876
US

IV. Provider business mailing address

119 BURBANK RD
LONGMEADOW MA
01106-1503
US

V. Phone/Fax

Practice location:
  • Phone: 413-592-4696
  • Fax: 413-592-4973
Mailing address:
  • Phone: 413-567-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19509
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: