Provider Demographics
NPI:1831360395
Name:FLEMMING, BRENDA MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MARIE
Last Name:FLEMMING
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 1:3865 UNION RD
Mailing Address - Street 2:TOPS MARKETS PHARMACY #202
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225
Mailing Address - Country:US
Mailing Address - Phone:716-684-5961
Mailing Address - Fax:716-681-1240
Practice Address - Street 1:3865 UNION RD
Practice Address - Street 2:TOPS MARKETS PHARMACY #202
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225
Practice Address - Country:US
Practice Address - Phone:716-684-5961
Practice Address - Fax:716-684-5961
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0461591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02351215Medicaid