Provider Demographics
NPI:1558661603
Name:HENZIG, BRIAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:HENZIG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E CALAVERAS BLVD
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7704
Mailing Address - Country:US
Mailing Address - Phone:408-262-9855
Mailing Address - Fax:408-262-9859
Practice Address - Street 1:555 E CALAVERAS BLVD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7704
Practice Address - Country:US
Practice Address - Phone:408-262-9855
Practice Address - Fax:408-262-9859
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist