Healthcare Provider Details

I. General information

NPI: 1568742294
Provider Name (Legal Business Name): KATHERINE KOCANDA-BREMMENKAMP RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BOSTON POST RD E
MARLBOROUGH MA
01752-3631
US

IV. Provider business mailing address

525 BOSTON POST RD E
MARLBOROUGH MA
01752-3631
US

V. Phone/Fax

Practice location:
  • Phone: 508-485-8752
  • Fax: 508-485-8930
Mailing address:
  • Phone: 508-485-8752
  • Fax: 508-485-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16533
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH26076
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: