Provider Demographics
NPI:1689131211
Name:O'LEARY, MICHAEL LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYNN
Last Name:O'LEARY
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 1:2895 N MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1882
Mailing Address - Country:US
Mailing Address - Phone:775-353-8818
Mailing Address - Fax:775-353-8821
Practice Address - Street 1:2895 N MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1882
Practice Address - Country:US
Practice Address - Phone:775-353-8818
Practice Address - Fax:775-353-8821
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist