Provider Demographics
NPI:1487249439
Name:O'BRIEN, KRISTY (PHARM D)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:RHATIGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:220 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2342
Mailing Address - Country:US
Mailing Address - Phone:773-895-9394
Mailing Address - Fax:
Practice Address - Street 1:11859 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1017
Practice Address - Country:US
Practice Address - Phone:773-895-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist