Healthcare Provider Details

I. General information

NPI: 1124461793
Provider Name (Legal Business Name): JANNA M BRENNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N SAINT HELEN RD
SAINT HELEN MI
48656-9209
US

IV. Provider business mailing address

2100 N SAINT HELEN RD PO BOX 38
SAINT HELEN MI
48656-9209
US

V. Phone/Fax

Practice location:
  • Phone: 989-389-7252
  • Fax: 989-389-7232
Mailing address:
  • Phone: 989-389-7252
  • Fax: 989-389-7232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302038803
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: