Provider Demographics
NPI:1427416973
Name:BREDENBERG, LAURA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BREDENBERG
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 1:2417 TERESA CIR
Mailing Address - Street 2:APT 417F
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6163
Mailing Address - Country:US
Mailing Address - Phone:716-880-7328
Mailing Address - Fax:
Practice Address - Street 1:2417 TERESA CIR
Practice Address - Street 2:APT 417F
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6163
Practice Address - Country:US
Practice Address - Phone:716-880-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist