Provider Demographics
NPI:1598859001
Name:WURM, BRENDA J (RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:WURM
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 1:93A 4TH ST.
Mailing Address - Street 2:BAYSHORE PHARMACY
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682
Mailing Address - Country:US
Mailing Address - Phone:231-271-6111
Mailing Address - Fax:231-271-0984
Practice Address - Street 1:93A 4TH ST.
Practice Address - Street 2:BAYSHORE PHARMACY
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682
Practice Address - Country:US
Practice Address - Phone:231-271-6111
Practice Address - Fax:231-271-0984
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist