Provider Demographics
NPI:1235341207
Name:OBRIAN, WILLIAM MITCHELL (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MITCHELL
Last Name:OBRIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 FIVE POINT RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2604
Mailing Address - Country:US
Mailing Address - Phone:757-496-8714
Mailing Address - Fax:757-496-8714
Practice Address - Street 1:1800 REPUBLIC DR.
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4542
Practice Address - Country:US
Practice Address - Phone:757-422-4509
Practice Address - Fax:757-422-4681
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist