Provider Demographics
NPI:1013910611
Name:O'BRIEN, DAVID A (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:O'BRIEN
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:PO BOX 2056
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:AK
Mailing Address - Zip Code:99574-2056
Mailing Address - Country:US
Mailing Address - Phone:907-424-5363
Mailing Address - Fax:907-424-5362
Practice Address - Street 1:516 FIRST ST.
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574-0220
Practice Address - Country:US
Practice Address - Phone:907-424-3246
Practice Address - Fax:907-424-3245
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist