Provider Demographics
NPI:1750715678
Name:LESESNE, BRENDA DAVIS (RPH)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:DAVIS
Last Name:LESESNE
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 1:415 E BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-4041
Mailing Address - Country:US
Mailing Address - Phone:843-264-3045
Mailing Address - Fax:
Practice Address - Street 1:415 E BROOKS RD
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-4041
Practice Address - Country:US
Practice Address - Phone:843-264-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC05384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist