Healthcare Provider Details

I. General information

NPI: 1619259959
Provider Name (Legal Business Name): BREANNA RACHELLE BERNARDUCCI PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BREANNA RACHELLE HIRVONEN

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 MCMILLAN RD
CLEMSON SC
29634-5400
US

IV. Provider business mailing address

735 MCMILLAN RD
CLEMSON SC
29634-0001
US

V. Phone/Fax

Practice location:
  • Phone: 864-656-0692
  • Fax:
Mailing address:
  • Phone: 864-656-3562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36159
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS018628
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: