MEDICARE: JENNIFER MARIE O'BRIEN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	18818	CO

General Provider Information

NPI Number	:	1134782139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE O'BRIEN PHARMD

Provider Business Mailing Address
First Line	:	2922 LA ESTRELLA CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-3314
Country	:	US
Telephone Number	:	719-357-0896
Fax Number	:

Provider Business Practice Location Address
First Line	:	4425 VENETUCCI BLVD
Second Line	:	PHARMACY
City	:	FOUNTAIN
State	:	CO
Zip	:	80906
Country	:	US
Telephone Number	:	719-313-4385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2019
Last Update Date	:	08/22/2019

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