Provider Demographics
NPI:1922372606
Name:BRENNAN, JAMES BRADLEY (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRADLEY
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:801 STOWE LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75068-4389
Mailing Address - Country:US
Mailing Address - Phone:972-978-5889
Mailing Address - Fax:
Practice Address - Street 1:801 STOWE LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75068-4389
Practice Address - Country:US
Practice Address - Phone:972-978-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist