Provider Demographics
NPI:1699579938
Name:BRENT, BRENDA LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:BRENT
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 E STATE HIGHWAY 164
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61447-9705
Mailing Address - Country:US
Mailing Address - Phone:319-759-2418
Mailing Address - Fax:
Practice Address - Street 1:1223 S GEAR AVE STE 109
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1685
Practice Address - Country:US
Practice Address - Phone:319-768-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA187301835C0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0206XPharmacy Service ProvidersPharmacistCardiology