Provider Demographics
NPI:1609178458
Name:BRENNAN, MARK (RPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:M
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:PO BOX 11265
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-3265
Mailing Address - Country:US
Mailing Address - Phone:775-338-4145
Mailing Address - Fax:775-586-9019
Practice Address - Street 1:212 ELKS POINT RD
Practice Address - Street 2:
Practice Address - City:ZEPHYR COVE
Practice Address - State:NV
Practice Address - Zip Code:89448-9800
Practice Address - Country:US
Practice Address - Phone:775-338-4145
Practice Address - Fax:775-586-9019
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV017631183500000X
OR0011837183500000X
CA64139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist