Provider Demographics
NPI:1134244619
Name:FAUTEUX, BRENDA SHIRLEY (RPH)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:SHIRLEY
Last Name:FAUTEUX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2749 RUSH HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8579
Mailing Address - Country:US
Mailing Address - Phone:843-856-8669
Mailing Address - Fax:843-856-1726
Practice Address - Street 1:1799 N HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3334
Practice Address - Country:US
Practice Address - Phone:843-856-8669
Practice Address - Fax:843-856-1726
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC09229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist