Provider Demographics
NPI:1467627315
Name:O'BRIEN, KASSIA (RPH)
Entity Type:Individual
Prefix:
First Name:KASSIA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
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:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:RI
Mailing Address - Zip Code:02898-0269
Mailing Address - Country:US
Mailing Address - Phone:401-539-6001
Mailing Address - Fax:401-539-1314
Practice Address - Street 1:21 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:RI
Practice Address - Zip Code:02898-1101
Practice Address - Country:US
Practice Address - Phone:401-539-6001
Practice Address - Fax:401-539-1314
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist