Provider Demographics
NPI:1518095892
Name:OBRYANT, CINDY L (RPH)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:OBRYANT
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 1:1164 COUNTY ROAD 170
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:OH
Mailing Address - Zip Code:43334-9637
Mailing Address - Country:US
Mailing Address - Phone:419-253-0977
Mailing Address - Fax:419-253-2736
Practice Address - Street 1:27 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:OH
Practice Address - Zip Code:43334
Practice Address - Country:US
Practice Address - Phone:419-253-3831
Practice Address - Fax:419-253-2736
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-20410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0288915Medicaid