Provider Demographics
NPI:1962755074
Name:BRANDNER, CONSTANCE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:MARIE
Last Name:BRANDNER
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 1:955 W CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6103
Mailing Address - Country:US
Mailing Address - Phone:715-832-8336
Mailing Address - Fax:715-832-5484
Practice Address - Street 1:955 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6103
Practice Address - Country:US
Practice Address - Phone:715-832-8336
Practice Address - Fax:715-832-5484
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11275-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist