Provider Demographics
NPI:1922377001
Name:BECK, BRENNAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRENNAN
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SPRINGHURST DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5950
Mailing Address - Country:US
Mailing Address - Phone:920-497-0985
Mailing Address - Fax:
Practice Address - Street 1:1150 SPRINGHURST DR
Practice Address - Street 2:SUITE 206
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5950
Practice Address - Country:US
Practice Address - Phone:920-497-0985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14132183500000X
IL293228183500000X
MI5302039363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist