Healthcare Provider Details

I. General information

NPI: 1568587038
Provider Name (Legal Business Name): KEVIN RICHARD O'BRIEN RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 DARTMOUTH ST
SOUTH DARTMOUTH MA
02748-3092
US

IV. Provider business mailing address

25 DELANO WAY
SOUTH DARTMOUTH MA
02748-2127
US

V. Phone/Fax

Practice location:
  • Phone: 508-990-3875
  • Fax:
Mailing address:
  • Phone: 508-996-5281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17654
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: