Provider Demographics
NPI:1457389652
Name:WARREN, BRENDA SMITH (DPH)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SMITH
Last Name:WARREN
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 SADDLE HILL CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-6189
Mailing Address - Country:US
Mailing Address - Phone:901-381-7162
Mailing Address - Fax:
Practice Address - Street 1:1640 CENTURY CENTER PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-8822
Practice Address - Country:US
Practice Address - Phone:901-381-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist