Provider Demographics
NPI:1679247118
Name:BRENNER, ANNA MARIE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:BRENNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 PINEY GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-3766
Mailing Address - Country:US
Mailing Address - Phone:716-604-6325
Mailing Address - Fax:
Practice Address - Street 1:601 N CAMPBELL STATION RD
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-1628
Practice Address - Country:US
Practice Address - Phone:865-675-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist