Provider Demographics
NPI:1427810910
Name:VILLANUEVA, BRENDA (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:VILLANUEVA
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 1:60825 GRAND TARGHEE DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-8115
Mailing Address - Country:US
Mailing Address - Phone:503-443-9464
Mailing Address - Fax:
Practice Address - Street 1:2650 NE HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6976
Practice Address - Country:US
Practice Address - Phone:541-383-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0019906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist