Provider Demographics
NPI:1821378563
Name:BREDA, AMY (RPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BREDA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:KEEFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:28901 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7120
Mailing Address - Country:US
Mailing Address - Phone:248-552-0847
Mailing Address - Fax:248-552-3705
Practice Address - Street 1:28901 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-7120
Practice Address - Country:US
Practice Address - Phone:248-552-0847
Practice Address - Fax:248-552-3705
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist