Provider Demographics
NPI:1700150349
Name:OBRIEN, JOHN MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
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 1:1965 RTE 57
Mailing Address - Street 2:SHOP RITE PHARMACY
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-3475
Mailing Address - Country:US
Mailing Address - Phone:908-852-2309
Mailing Address - Fax:908-852-0860
Practice Address - Street 1:1965 RTE 57
Practice Address - Street 2:SHOP RITE PHARMACY
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-3475
Practice Address - Country:US
Practice Address - Phone:908-852-2309
Practice Address - Fax:908-852-0860
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01946200183500000X
PARP444535183500000X
FLPS46349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01946200OtherNEW JERSEY BOARD OF PHARMACY