Provider Demographics
NPI:1497881650
Name:FONVILLE, BRENDA HALL (RPH)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:HALL
Last Name:FONVILLE
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 1:404 BAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1001
Mailing Address - Country:US
Mailing Address - Phone:910-867-3557
Mailing Address - Fax:
Practice Address - Street 1:1431 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4405
Practice Address - Country:US
Practice Address - Phone:910-486-5936
Practice Address - Fax:910-486-9227
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist