Provider Demographics
NPI:1306625082
Name:BRENNAN, JOSEPH (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BRENNAN
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 1:300 HUNTERS CROSSING DR APT 108
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-8755
Mailing Address - Country:US
Mailing Address - Phone:609-678-5996
Mailing Address - Fax:
Practice Address - Street 1:8085 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1203
Practice Address - Country:US
Practice Address - Phone:440-717-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist