Provider Demographics
NPI:1154604940
Name:BRENDLE, LARRY JAY (RPH)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JAY
Last Name:BRENDLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4489 CHASTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1269
Mailing Address - Country:US
Mailing Address - Phone:321-773-4496
Mailing Address - Fax:321-242-2955
Practice Address - Street 1:4489 CHASTAIN DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1269
Practice Address - Country:US
Practice Address - Phone:321-773-4496
Practice Address - Fax:321-242-2955
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist