Provider Demographics
NPI:1134722804
Name:HOMAN, BRENT ANTHONY (RPH)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:ANTHONY
Last Name:HOMAN
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 1:117 CARDINAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-1042
Mailing Address - Country:US
Mailing Address - Phone:937-269-4592
Mailing Address - Fax:401-406-3522
Practice Address - Street 1:32 N LUDLOW ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1826
Practice Address - Country:US
Practice Address - Phone:937-269-4592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03226182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist