Provider Demographics
NPI:1275801813
Name:BREWSTER, RENEE NADINE
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:NADINE
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8623
Mailing Address - Country:US
Mailing Address - Phone:303-209-0107
Mailing Address - Fax:
Practice Address - Street 1:400 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8623
Practice Address - Country:US
Practice Address - Phone:303-209-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist