Provider Demographics
NPI:1861772337
Name:OBERMEYER, DAVID ALAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:OBERMEYER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4220
Mailing Address - Country:US
Mailing Address - Phone:262-635-0181
Mailing Address - Fax:262-635-1865
Practice Address - Street 1:4810 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4220
Practice Address - Country:US
Practice Address - Phone:262-635-0181
Practice Address - Fax:262-635-1865
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11730-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist