Provider Demographics
NPI:1760263024
Name:BREDEMEYER, DEBRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BREDEMEYER
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 1:19263 MORRISON WAY
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1174
Mailing Address - Country:US
Mailing Address - Phone:317-698-9334
Mailing Address - Fax:
Practice Address - Street 1:2550 CONNER ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3139
Practice Address - Country:US
Practice Address - Phone:317-773-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020125A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist