Healthcare Provider Details

I. General information

NPI: 1235341207
Provider Name (Legal Business Name): WILLIAM MITCHELL OBRIAN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 REPUBLIC DR.
VIRGINIA BEACH VA
23454-4542
US

IV. Provider business mailing address

913 FIVE POINT RD
VIRGINIA BEACH VA
23454-2604
US

V. Phone/Fax

Practice location:
  • Phone: 757-422-4509
  • Fax: 757-422-4681
Mailing address:
  • Phone: 757-496-8714
  • Fax: 757-496-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202004719
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: