Healthcare Provider Details

I. General information

NPI: 1972749794
Provider Name (Legal Business Name): SONJA LYNN OBRYAN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 E THORNRIDGE DR
BOLIVAR MO
65613-1283
US

IV. Provider business mailing address

1885 E THORNRIDGE DR
BOLIVAR MO
65613-1283
US

V. Phone/Fax

Practice location:
  • Phone: 417-326-2524
  • Fax:
Mailing address:
  • Phone: 417-326-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044221
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: