Provider Demographics
NPI:1538437843
Name:OBRIEN, LISA LYNN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 BROOKS AVE. E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2101
Mailing Address - Country:US
Mailing Address - Phone:651-779-4368
Mailing Address - Fax:
Practice Address - Street 1:2920 WHITE BEAR AVE NORTH
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1304
Practice Address - Country:US
Practice Address - Phone:651-251-9938
Practice Address - Fax:651-251-9944
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist