Provider Demographics
NPI:1962013037
Name:BRENNAN, PATRICK J (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-2525
Mailing Address - Country:US
Mailing Address - Phone:203-468-9732
Mailing Address - Fax:
Practice Address - Street 1:157 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2525
Practice Address - Country:US
Practice Address - Phone:203-481-0386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist