Provider Demographics
NPI:1063403970
Name:MARTIN, BRENDA RAE (RPH)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:RAE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPH
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Mailing Address - Street 1:309 E PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1710
Mailing Address - Country:US
Mailing Address - Phone:913-557-3562
Mailing Address - Fax:913-755-7045
Practice Address - Street 1:OSAWATOMIE STATE HOSPITAL
Practice Address - Street 2:RT 1 BOX 500
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064
Practice Address - Country:US
Practice Address - Phone:913-755-7213
Practice Address - Fax:913-755-7045
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS116861835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric