Provider Demographics
NPI:1174705826
Name:OBERNESSER, LOU ANN R (RPH)
Entity type:Individual
Prefix:MRS
First Name:LOU ANN
Middle Name:R
Last Name:OBERNESSER
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:RITE AID OFFICE 1218 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-459-4053
Mailing Address - Fax:518-459-4106
Practice Address - Street 1:1218 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5329
Practice Address - Country:US
Practice Address - Phone:518-459-4053
Practice Address - Fax:518-459-4106
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist