Healthcare Provider Details

I. General information

NPI: 1487927273
Provider Name (Legal Business Name): BRENDA SUE EOFF CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SW EMIGRANT AVE
PENDLETON OR
97801-1948
US

IV. Provider business mailing address

901 SW EMIGRANT AVE
PENDLETON OR
97801-1948
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-7909
  • Fax: 541-276-2101
Mailing address:
  • Phone: 541-276-7909
  • Fax: 541-276-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberCPT-0003201
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: