Provider Demographics
NPI:1780992776
Name:HARLOW, BRENDA TRIBBLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:TRIBBLE
Last Name:HARLOW
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 1:93 WINDMERE DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-8045
Mailing Address - Country:US
Mailing Address - Phone:662-226-0990
Mailing Address - Fax:
Practice Address - Street 1:2616 HIGHWAY 82 E
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-6069
Practice Address - Country:US
Practice Address - Phone:662-455-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE7068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist