Provider Demographics
NPI:1194013011
Name:GROLEMUND, BRANDIE NICHOLE (RPHT)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:NICHOLE
Last Name:GROLEMUND
Suffix:
Gender:F
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 CORTEZ RD W
Mailing Address - Street 2:PHARMACY
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3146
Mailing Address - Country:US
Mailing Address - Phone:941-792-7325
Mailing Address - Fax:941-792-7506
Practice Address - Street 1:4651 CORTEZ RD W
Practice Address - Street 2:PHARMACY
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3146
Practice Address - Country:US
Practice Address - Phone:941-792-7325
Practice Address - Fax:941-792-7506
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT10432183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician