Provider Demographics
NPI:1295456564
Name:BILODEAU, BRENDAN (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:BILODEAU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CARTERET ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-1513
Mailing Address - Country:US
Mailing Address - Phone:401-440-3830
Mailing Address - Fax:
Practice Address - Street 1:58 CARTERET ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1513
Practice Address - Country:US
Practice Address - Phone:401-440-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist