Healthcare Provider Details

I. General information

NPI: 1598996027
Provider Name (Legal Business Name): PATRICK DAVID OBRIEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 NINA LN
MUSKEGON MI
49441-4200
US

IV. Provider business mailing address

133 E DIVISION ST
SPARTA MI
49345-1329
US

V. Phone/Fax

Practice location:
  • Phone: 231-343-2598
  • Fax:
Mailing address:
  • Phone: 231-343-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302032408
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: