Provider Demographics
NPI:1457520629
Name:BRENNAN, BETH (PHARM D)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 SACKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1109
Mailing Address - Country:US
Mailing Address - Phone:516-750-8685
Mailing Address - Fax:
Practice Address - Street 1:490 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2700
Practice Address - Country:US
Practice Address - Phone:516-292-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY049828OtherSTATE LICENSE NUMBER