Provider Demographics
NPI:1700155728
Name:BRETT, EVANGELINE L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:EVANGELINE
Middle Name:L
Last Name:BRETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:EVA
Other - Middle Name:L
Other - Last Name:BRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3320 S BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-6528
Mailing Address - Country:US
Mailing Address - Phone:920-452-5858
Mailing Address - Fax:920-452-4968
Practice Address - Street 1:3320 S BUSINESS DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-6528
Practice Address - Country:US
Practice Address - Phone:920-452-5858
Practice Address - Fax:920-452-4968
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist