Provider Demographics
NPI:1750662615
Name:VAN VELDHUIZEN, BRENDA D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:D
Last Name:VAN VELDHUIZEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-1616
Mailing Address - Country:US
Mailing Address - Phone:608-781-0791
Mailing Address - Fax:
Practice Address - Street 1:2626 ROSE ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-1616
Practice Address - Country:US
Practice Address - Phone:608-781-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156955-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist