Provider Demographics
NPI:1114420569
Name:ENDERBY, BRIANNA
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:
Last Name:ENDERBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 COOLIDGE DR APT 11
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-5727
Mailing Address - Country:US
Mailing Address - Phone:412-719-3334
Mailing Address - Fax:
Practice Address - Street 1:11 COOLIDGE DR APT 11
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-5727
Practice Address - Country:US
Practice Address - Phone:412-719-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist