Provider Demographics
NPI:1508574799
Name:BRENT, CARLY ANN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ANN
Last Name:BRENT
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5552 DUNLAY DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2160
Mailing Address - Country:US
Mailing Address - Phone:916-694-9287
Mailing Address - Fax:
Practice Address - Street 1:340 WOODSIDE PLZ
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3259
Practice Address - Country:US
Practice Address - Phone:650-368-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist