Provider Demographics
NPI:1336465244
Name:OBRIEN, THOMAS M (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
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 1:1633 MADISON PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1822
Mailing Address - Country:US
Mailing Address - Phone:718-627-5993
Mailing Address - Fax:
Practice Address - Street 1:1633 MADISON PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1822
Practice Address - Country:US
Practice Address - Phone:718-627-5993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030268-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist