Provider Demographics
NPI:1871103622
Name:O'BRIEN, MELINDA (RPH)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4775 LARIMER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9023
Mailing Address - Country:US
Mailing Address - Phone:970-461-9101
Mailing Address - Fax:970-461-9089
Practice Address - Street 1:4775 LARIMER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9023
Practice Address - Country:US
Practice Address - Phone:970-461-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist