Healthcare Provider Details

I. General information

NPI: 1912629031
Provider Name (Legal Business Name): BRENNA GELEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5844 SOUTHWESTERN BLVD STE 500
HAMBURG NY
14075-3685
US

IV. Provider business mailing address

157 N 2ND ST
ALLEGANY NY
14706-1046
US

V. Phone/Fax

Practice location:
  • Phone: 716-800-2273
  • Fax:
Mailing address:
  • Phone: 716-378-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number069245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: