Provider Demographics
NPI:1326606120
Name:COMSTOCK, BREANNA DEE (CERT PHARMACY TECH)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:DEE
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:CERT PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1119
Mailing Address - Country:US
Mailing Address - Phone:208-884-5475
Mailing Address - Fax:208-887-7876
Practice Address - Street 1:3301 W CHERRY LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1119
Practice Address - Country:US
Practice Address - Phone:208-884-5475
Practice Address - Fax:208-887-7876
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCT1182183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician