Healthcare Provider Details

I. General information

NPI: 1932433687
Provider Name (Legal Business Name): MAUREEN ANN O'BRIEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WATERS PLACE BRONX PSYCHIATRIC CENTER
BRONX NY
10461
US

IV. Provider business mailing address

1500 WATERS PLACE BRONX PSYCHIATRIC CENTER
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-862-5028
  • Fax: 718-221-7330
Mailing address:
  • Phone: 718-862-5028
  • Fax: 914-736-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36770
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: