Provider Demographics
NPI:1124380274
Name:BRANDSEMA, COLLEEN MEGAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MEGAN
Last Name:BRANDSEMA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 OAK TREE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-4061
Mailing Address - Country:US
Mailing Address - Phone:336-491-4212
Mailing Address - Fax:
Practice Address - Street 1:1909 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2926
Practice Address - Country:US
Practice Address - Phone:336-227-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist