Provider Demographics
NPI:1225650799
Name:SPENCE, BRENDAN JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:JAMES
Last Name:SPENCE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 SMYTHBERRY LN APT 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-8210
Mailing Address - Country:US
Mailing Address - Phone:630-642-0600
Mailing Address - Fax:
Practice Address - Street 1:2140 N PEORIA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-1840
Practice Address - Country:US
Practice Address - Phone:217-544-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.302118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051.302118OtherPHARMACIST LICENSE