Provider Demographics
NPI:1437795556
Name:BRENNEMAN, EMILY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:BRENNEMAN
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 1:1175 S COLLEGE MALL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-6290
Mailing Address - Country:US
Mailing Address - Phone:812-361-7376
Mailing Address - Fax:812-323-4305
Practice Address - Street 1:1175 S COLLEGE MALL RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-6290
Practice Address - Country:US
Practice Address - Phone:812-361-7376
Practice Address - Fax:812-323-4305
Is Sole Proprietor?:No
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ26021408A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist