Healthcare Provider Details

I. General information

NPI: 1518095892
Provider Name (Legal Business Name): CINDY L OBRYANT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SOUTH MAIN ST
MARENGO OH
43334
US

IV. Provider business mailing address

1164 COUNTY ROAD 170
MARENGO OH
43334-9637
US

V. Phone/Fax

Practice location:
  • Phone: 419-253-3831
  • Fax: 419-253-2736
Mailing address:
  • Phone: 419-253-0977
  • Fax: 419-253-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-20410
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: