Provider Demographics
NPI:1194875401
Name:HALLING, BRENDA JANELLE (RPH)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JANELLE
Last Name:HALLING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 HULL AVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-8088
Mailing Address - Country:US
Mailing Address - Phone:515-465-2228
Mailing Address - Fax:
Practice Address - Street 1:710 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-1544
Practice Address - Country:US
Practice Address - Phone:641-332-2201
Practice Address - Fax:641-332-2702
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist