Provider Demographics
NPI:1932516291
Name:WREN, BRENDAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:
Last Name:WREN
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 1:71 1/2 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-2420
Mailing Address - Country:US
Mailing Address - Phone:518-466-6080
Mailing Address - Fax:
Practice Address - Street 1:522 S 2ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2409
Practice Address - Country:US
Practice Address - Phone:215-625-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist