Provider Demographics
NPI:1770615452
Name:O'BRIEN, JOHN GRANT (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GRANT
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:GRANT
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6146 CALLE ESPERANZA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4406
Mailing Address - Country:US
Mailing Address - Phone:408-323-1524
Mailing Address - Fax:408-885-4699
Practice Address - Street 1:2400 MOORPARK AVE
Practice Address - Street 2:SUITE 316B, IRA GREENE PACE CLINIC
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2631
Practice Address - Country:US
Practice Address - Phone:408-885-7615
Practice Address - Fax:408-885-4699
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456831835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy