Healthcare Provider Details

I. General information

NPI: 1881503092
Provider Name (Legal Business Name): BRENNEN DOUGLAS BARNES CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1979 LIME KILN RD
BELLEVUE WI
54311-6219
US

IV. Provider business mailing address

2214 TRELLIS RIDGE LN APT 3
DE PERE WI
54115-4513
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-0638
  • Fax:
Mailing address:
  • Phone: 920-639-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number232526-41
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: