Provider Demographics
NPI:1053684266
Name:EPPS, BRENDA (RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:EPPS
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 1:23801 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23841-3317
Mailing Address - Country:US
Mailing Address - Phone:804-469-9139
Mailing Address - Fax:804-469-9139
Practice Address - Street 1:21414 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23803-2408
Practice Address - Country:US
Practice Address - Phone:804-469-9139
Practice Address - Fax:804-469-9139
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist