Provider Demographics
NPI:1801186465
Name:BRENNAN, COLLEEN M (RPH)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:BRENNAN
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 1:10 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3001
Mailing Address - Country:US
Mailing Address - Phone:570-628-2537
Mailing Address - Fax:570-628-5334
Practice Address - Street 1:10 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3001
Practice Address - Country:US
Practice Address - Phone:570-628-2537
Practice Address - Fax:570-628-5334
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037969L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist