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General NPI Number Information
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NPI Number | 1538093562
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Entity Type | Individual
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Provider Name | SUSAN DECENZO OBRIEN RPH
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Gender | Female
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Dates
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Enumeration Date | 06/12/2026
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Last Update Date | 06/12/2026
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Provider Practice Location Address
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Address Line | 1500 LEE BLVD
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-4835
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Country | US
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Telephone | 239-369-2101
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Fax |
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Provider Business Mailing Address
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Address Line | 10700 RAVENNA WAY UNIT 305
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City | FORT MYERS
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State | FL
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Zip | 33913-7047
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Country | US
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Telephone | 774-836-3695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS22380
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License Number State | FL
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