Provider Demographics
NPI:1346891355
Name:HILL, BRENDAL JACKLYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRENDAL
Middle Name:JACKLYN
Last Name:HILL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BRENDAL
Other - Middle Name:JACKLYN
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2704
Mailing Address - Country:US
Mailing Address - Phone:304-907-6627
Mailing Address - Fax:
Practice Address - Street 1:1110 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2704
Practice Address - Country:US
Practice Address - Phone:304-907-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59939183500000X
WVRP0012419183500000X
TN43337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist