Provider Demographics
NPI:1982108700
Name:BRENNECKE, STEVEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:BRENNECKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6506
Mailing Address - Country:US
Mailing Address - Phone:760-815-6030
Mailing Address - Fax:
Practice Address - Street 1:7660 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-7901
Practice Address - Country:US
Practice Address - Phone:760-633-0037
Practice Address - Fax:760-633-3597
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist