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General NPI Number Information
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NPI Number | 1104461862
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Entity Type | Individual
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Provider Name | BRENDA DENISE CARLILE RPH
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Gender | Female
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Dates
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Enumeration Date | 11/16/2019
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Last Update Date | 11/16/2019
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Provider Practice Location Address
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Address Line | 4500 N MAIN ST
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City | ROSWELL
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State | NM
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Zip | 88201-0305
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Country | US
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Telephone | 575-624-2904
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Fax |
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Provider Business Mailing Address
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Address Line | 42151 LITTLE RIVER RD
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City | TECUMSEH
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State | OK
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Zip | 74873-7576
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Country | US
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Telephone | 719-369-3022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP00005850
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License Number State | NM
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