=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487171682
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDEN JAMES KING PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2017
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 645 S ROGERS ST STE C
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47403-2353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-355-6340
-----------------------------------------------------
Fax | 812-332-4369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4912 S SHORE DR
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47448-8288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-490-1714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26022606A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------