Provider Demographics
NPI:1225372089
Name:BRIZENDINE, JEANINE (RPH PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:
Last Name:BRIZENDINE
Suffix:
Gender:F
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 1:2331 N BRANDON CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4511
Mailing Address - Country:US
Mailing Address - Phone:316-630-8067
Mailing Address - Fax:316-630-8170
Practice Address - Street 1:2331 N BRANDON CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4511
Practice Address - Country:US
Practice Address - Phone:316-630-8067
Practice Address - Fax:316-630-8170
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS108761835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy