Provider Demographics
NPI:1992305692
Name:GENTRY, BRENNA SUZANNE (RPH)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:SUZANNE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:SUZANNE
Other - Last Name:KINDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:516 ENDICOTT DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7080
Mailing Address - Country:US
Mailing Address - Phone:580-371-1477
Mailing Address - Fax:
Practice Address - Street 1:3333 N US HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2525
Practice Address - Country:US
Practice Address - Phone:903-891-4440
Practice Address - Fax:903-891-9302
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30993183500000X
TX34806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist