Healthcare Provider Details

I. General information

NPI: 1912242447
Provider Name (Legal Business Name): ADRIA TUPPER O'BRIEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 BAYLOR DR
BLUFFTON SC
29910-8902
US

IV. Provider business mailing address

80 BAYLOR DR
BLUFFTON SC
29910-8902
US

V. Phone/Fax

Practice location:
  • Phone: 843-706-3504
  • Fax: 843-706-3049
Mailing address:
  • Phone: 843-706-3504
  • Fax: 843-706-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number008221
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: