Provider Demographics
NPI:1205324712
Name:ARMENTROUT, BRENDA KAYE (RPH)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAYE
Last Name:ARMENTROUT
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 1:207 N TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-1325
Mailing Address - Country:US
Mailing Address - Phone:260-463-9370
Mailing Address - Fax:260-463-9457
Practice Address - Street 1:207 N TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-1325
Practice Address - Country:US
Practice Address - Phone:260-463-9370
Practice Address - Fax:260-463-9457
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013718A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist