Provider Demographics
NPI:1356001978
Name:BRANDT, JANINE (RPH)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:BRANDT
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 1:98 PARISH HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06256-1224
Mailing Address - Country:US
Mailing Address - Phone:860-917-1150
Mailing Address - Fax:
Practice Address - Street 1:529 TALCOTTVILLE RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-2311
Practice Address - Country:US
Practice Address - Phone:860-871-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0007621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist