Provider Demographics
NPI:1336551779
Name:O'BRIEN, JOHN HENRY IV (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HENRY
Last Name:O'BRIEN
Suffix:IV
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4246 E AHWATUKEE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3103
Mailing Address - Country:US
Mailing Address - Phone:480-747-3692
Mailing Address - Fax:
Practice Address - Street 1:44274 W SMITH ENKE RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2719
Practice Address - Country:US
Practice Address - Phone:520-568-8290
Practice Address - Fax:520-568-8296
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019906183500000X
FLPS51639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist