Healthcare Provider Details

I. General information

NPI: 1376867192
Provider Name (Legal Business Name): JOHN J OBRIEN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 CYPRESS AVE
LANGHORNE PA
19047-5909
US

IV. Provider business mailing address

834 CYPRESS AVE
LANGHORNE PA
19047-5909
US

V. Phone/Fax

Practice location:
  • Phone: 215-710-7427
  • Fax: 215-710-7434
Mailing address:
  • Phone: 215-710-7427
  • Fax: 215-710-7434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP027693L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: