Provider Demographics
NPI:1124461793
Name:BRENNER, JANNA M (PHARMD)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:M
Last Name:BRENNER
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 1:2100 N SAINT HELEN RD
Mailing Address - Street 2:PO BOX 38
Mailing Address - City:SAINT HELEN
Mailing Address - State:MI
Mailing Address - Zip Code:48656-9209
Mailing Address - Country:US
Mailing Address - Phone:989-389-7252
Mailing Address - Fax:989-389-7232
Practice Address - Street 1:2100 N SAINT HELEN RD
Practice Address - Street 2:
Practice Address - City:SAINT HELEN
Practice Address - State:MI
Practice Address - Zip Code:48656-9209
Practice Address - Country:US
Practice Address - Phone:989-389-7252
Practice Address - Fax:989-389-7232
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist