Healthcare Provider Details

I. General information

NPI: 1396332383
Provider Name (Legal Business Name): BRENDA KOBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2020
Last Update Date: 12/24/2020
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 W WINNECONNE AVE
NEENAH WI
54956-3693
US

IV. Provider business mailing address

W7283 SUNFIELD DR
GREENVILLE WI
54942-8780
US

V. Phone/Fax

Practice location:
  • Phone: 920-722-1185
  • Fax:
Mailing address:
  • Phone: 920-205-9539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14487-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: