Provider Demographics
NPI:1104003896
Name:FORD, BRENDA MARY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MARY
Last Name:FORD
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 1:9141 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-9645
Mailing Address - Country:US
Mailing Address - Phone:814-774-8880
Mailing Address - Fax:814-774-1169
Practice Address - Street 1:9141 RIDGE RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:PA
Practice Address - Zip Code:16417-9645
Practice Address - Country:US
Practice Address - Phone:814-774-8880
Practice Address - Fax:814-774-1169
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041804L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP041804LOtherSTATE LICENSE NUMBER