Provider Demographics
NPI:1235395658
Name:RENNER, BRANDY LEIGH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:LEIGH
Last Name:RENNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 N. LITCHFIELD RD
Mailing Address - Street 2:56 MEDICAL GROUP
Mailing Address - City:LUKE AFB
Mailing Address - State:AZ
Mailing Address - Zip Code:85309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 MEDICAL GROUP
Practice Address - Street 2:7219 NORTH LITCHFIELD RD
Practice Address - City:LUKE AFB
Practice Address - State:AZ
Practice Address - Zip Code:85309
Practice Address - Country:US
Practice Address - Phone:623-856-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA202210978183500000X
VA0202210978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist