Healthcare Provider Details

I. General information

NPI: 1366570764
Provider Name (Legal Business Name): DEBORAH LEE BREWER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MAIN STREET
SANDY HOOK KY
41171
US

IV. Provider business mailing address

MAIN STREET P.O. BOX 187
SANDY HOOK KY
41171
US

V. Phone/Fax

Practice location:
  • Phone: 606-738-5111
  • Fax: 606-738-4018
Mailing address:
  • Phone: 606-738-5111
  • Fax: 606-738-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number008280
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: