Provider Demographics
NPI:1720360373
Name:BREMER, DOREEN ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:ELIZABETH
Last Name:BREMER
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 1:175 MALABAR RD NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2944
Mailing Address - Country:US
Mailing Address - Phone:321-728-4055
Mailing Address - Fax:
Practice Address - Street 1:175 MALABAR RD NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2944
Practice Address - Country:US
Practice Address - Phone:321-728-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL183500000XOtherWALGREENS