Provider Demographics
NPI:1215528567
Name:CARROLL, BRENDA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:CARROLL
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 1:921 BEASLEY ST STE 130
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4119
Mailing Address - Country:US
Mailing Address - Phone:859-299-2161
Mailing Address - Fax:
Practice Address - Street 1:921 BEASLEY ST STE 130
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4119
Practice Address - Country:US
Practice Address - Phone:859-299-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist