Provider Demographics
NPI:1851302400
Name:THE O'BRYAN COMPANY INC
Entity Type:Organization
Organization Name:THE O'BRYAN COMPANY INC
Other - Org Name:PACIFIC WEST HEALTHCARE SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-852-4222
Mailing Address - Street 1:5151 GOLDEN FOOTHILL PKWY
Mailing Address - Street 2:STE 140
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9609
Mailing Address - Country:US
Mailing Address - Phone:916-852-4222
Mailing Address - Fax:916-852-0951
Practice Address - Street 1:5151 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:STE 140
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9609
Practice Address - Country:US
Practice Address - Phone:916-852-4222
Practice Address - Fax:916-852-0951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336M0002X
CAPHY482063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5600641OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA5656180002Medicare NSC