Provider Demographics
NPI:1568755270
Name:O'BRIEN, YVONNE CLARK (RPH)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:CLARK
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 10
Mailing Address - Street 2:13 LINDA LANE
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-0010
Mailing Address - Country:US
Mailing Address - Phone:631-878-8115
Mailing Address - Fax:
Practice Address - Street 1:812 MONTAUK HIGHWAY
Practice Address - Street 2:WALDBAUMS INC
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-0000
Practice Address - Country:US
Practice Address - Phone:631-874-9025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist