Provider Demographics
NPI:1619570900
Name:PELLMANN, BRIAN ERIC (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ERIC
Last Name:PELLMANN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 BRIAN AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8163
Mailing Address - Country:US
Mailing Address - Phone:814-695-7020
Mailing Address - Fax:
Practice Address - Street 1:221 GLIMCHER DR
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-9415
Practice Address - Country:US
Practice Address - Phone:814-695-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037212L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist