Provider Demographics
NPI:1962497701
Name:BREWER, CONSUELO K (RPH, BCNSP)
Entity Type:Individual
Prefix:MRS
First Name:CONSUELO
Middle Name:K
Last Name:BREWER
Suffix:
Gender:F
Credentials:RPH, BCNSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 RUSHING WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-2040
Mailing Address - Country:US
Mailing Address - Phone:614-792-2545
Mailing Address - Fax:614-234-5535
Practice Address - Street 1:793 W STATE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1551
Practice Address - Country:US
Practice Address - Phone:614-234-5830
Practice Address - Fax:614-234-5535
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031150481835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support