Provider Demographics
NPI:1679261382
Name:FINK, BRENDA JEAN
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JEAN
Last Name:FINK
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 1:152 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3517
Mailing Address - Country:US
Mailing Address - Phone:607-434-4510
Mailing Address - Fax:
Practice Address - Street 1:94 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2470
Practice Address - Country:US
Practice Address - Phone:607-432-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist