Provider Demographics
NPI:1063067262
Name:DOERING, BRANDELYN (PHARMD)
Entity type:Individual
Prefix:
First Name:BRANDELYN
Middle Name:
Last Name:DOERING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14839 S 46TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6860
Mailing Address - Country:US
Mailing Address - Phone:602-670-9569
Mailing Address - Fax:
Practice Address - Street 1:1230 S LONGMORE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-9602
Practice Address - Country:US
Practice Address - Phone:480-281-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist