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General NPI Number Information
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NPI Number | 1134734593
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Entity Type | Individual
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Provider Name | BRENDON CLOUGH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/12/2020
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Last Update Date | 09/12/2020
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Provider Practice Location Address
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Address Line | 1929 PRESTON RD
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City | PLANO
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State | TX
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Zip | 75093-5102
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Country | US
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Telephone | 972-713-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 8275 WALNUT HILL LN APT 223
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City | DALLAS
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State | TX
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Zip | 75231-4586
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Country | US
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Telephone | 817-219-4926
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 64664
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License Number State | TX
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