Healthcare Provider Details

I. General information

NPI: 1871875161
Provider Name (Legal Business Name): DAWN MARIE OBRIEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S COMMERCIAL ST
NEENAH WI
54956-3383
US

IV. Provider business mailing address

500 S COMMERCIAL STREET
NEENAH WI
54956
US

V. Phone/Fax

Practice location:
  • Phone: 920-729-1311
  • Fax: 920-729-0879
Mailing address:
  • Phone: 920-729-1311
  • Fax: 920-729-0879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11942-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: