Provider Demographics
NPI:1184834137
Name:JAWORSKI, BRENDA A (RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:JAWORSKI
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 1:130 OLD US 2
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49968-9534
Mailing Address - Country:US
Mailing Address - Phone:231-429-5854
Mailing Address - Fax:
Practice Address - Street 1:802 E CLOVERLAND DR
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-1502
Practice Address - Country:US
Practice Address - Phone:906-932-4267
Practice Address - Fax:906-932-4609
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410688183500000X
WI14292-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist