Provider Demographics
NPI:1164026043
Name:CALDER, BRENT NICOLAS (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:NICOLAS
Last Name:CALDER
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1329
Mailing Address - Country:US
Mailing Address - Phone:678-423-1043
Mailing Address - Fax:
Practice Address - Street 1:2305 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1329
Practice Address - Country:US
Practice Address - Phone:678-423-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist