Provider Demographics
NPI:1245766963
Name:MCPHERON, BRENDA J (RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:MCPHERON
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 1:2129 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1557
Mailing Address - Country:US
Mailing Address - Phone:937-592-3464
Mailing Address - Fax:937-593-2343
Practice Address - Street 1:2129 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1557
Practice Address - Country:US
Practice Address - Phone:937-592-3464
Practice Address - Fax:937-593-2343
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03314232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist