Provider Demographics
NPI:1083936363
Name:TATE, BRENDA LOUISE (R PH)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LOUISE
Last Name:TATE
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S ROYAL OAKS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1310
Mailing Address - Country:US
Mailing Address - Phone:615-791-5920
Mailing Address - Fax:615-791-6253
Practice Address - Street 1:209 S ROYAL OAKS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1310
Practice Address - Country:US
Practice Address - Phone:615-791-5920
Practice Address - Fax:615-791-6253
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist