Provider Demographics
NPI:1912205857
Name:CONRADI, BRENDA LILES (RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LILES
Last Name:CONRADI
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 1:641 OLLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-2236
Mailing Address - Country:US
Mailing Address - Phone:205-755-5879
Mailing Address - Fax:205-280-6975
Practice Address - Street 1:641 OLLIE AVE
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2236
Practice Address - Country:US
Practice Address - Phone:205-755-5879
Practice Address - Fax:205-280-6975
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist