Provider Demographics
NPI:1346212677
Name:PEDOTA, BRENDA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:ANN
Last Name:PEDOTA
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 1:4715 RICE MINE RD NE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2648
Mailing Address - Country:US
Mailing Address - Phone:205-345-3455
Mailing Address - Fax:
Practice Address - Street 1:4715 RICE MINE RD NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2648
Practice Address - Country:US
Practice Address - Phone:205-345-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL13719OtherPHARMACIST LICENSE