Provider Demographics
NPI:1497093850
Name:BRENDEN, BARRY DREW
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:DREW
Last Name:BRENDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-4403
Mailing Address - Country:US
Mailing Address - Phone:253-840-8183
Mailing Address - Fax:253-840-8177
Practice Address - Street 1:1100 N MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-4403
Practice Address - Country:US
Practice Address - Phone:253-840-8183
Practice Address - Fax:253-840-8177
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist