Provider Demographics
NPI:1083931117
Name:O'BRIEN, STEPHANIE C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:C
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10864 TEA OLIVE LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4845
Mailing Address - Country:US
Mailing Address - Phone:561-470-6126
Mailing Address - Fax:
Practice Address - Street 1:2955 W CORPORATE LAKES BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3663
Practice Address - Country:US
Practice Address - Phone:954-660-5555
Practice Address - Fax:954-660-5643
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS390081835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric