Provider Demographics
NPI:1790876613
Name:HOGAN, BRENDA L (RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:HOGAN
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 1:71 CANOE RUN RD
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223-4706
Mailing Address - Country:US
Mailing Address - Phone:603-494-6145
Mailing Address - Fax:
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NH
Practice Address - Zip Code:03251
Practice Address - Country:US
Practice Address - Phone:603-745-5660
Practice Address - Fax:603-745-9831
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHLICENSE #2258OtherSTATE PHARMACY LICENSE