Provider Demographics
NPI:1912114984
Name:MCBRIDE, BRENDA KING (RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KING
Last Name:MCBRIDE
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 1:6 CRYSTAL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GILMANTON IRON WORKS
Mailing Address - State:NH
Mailing Address - Zip Code:01837
Mailing Address - Country:US
Mailing Address - Phone:603-364-7861
Mailing Address - Fax:
Practice Address - Street 1:724 N MAIN ST
Practice Address - Street 2:AT THE LACONIA CLINIC
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246
Practice Address - Country:US
Practice Address - Phone:603-524-5064
Practice Address - Fax:603-527-2793
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR0563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist