Provider Demographics
NPI:1134451354
Name:MAYHEW, BRENNA C (RPH)
Entity type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:C
Last Name:MAYHEW
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 1:72388 RIDGECREST LN
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-6240
Mailing Address - Country:US
Mailing Address - Phone:760-408-3975
Mailing Address - Fax:
Practice Address - Street 1:366 S PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7302
Practice Address - Country:US
Practice Address - Phone:760-325-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH31917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
376042OtherNABP