Provider Demographics
NPI:1598996027
Name:OBRIEN, PATRICK DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DAVID
Last Name:OBRIEN
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 1:133 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-1329
Mailing Address - Country:US
Mailing Address - Phone:231-343-2598
Mailing Address - Fax:
Practice Address - Street 1:3370 NINA LN
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4200
Practice Address - Country:US
Practice Address - Phone:231-343-2598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist