Provider Demographics
NPI:1043538515
Name:REBHOLZ, BRIAN WILLIAM (PHARMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:WILLIAM
Last Name:REBHOLZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8071
Mailing Address - Country:US
Mailing Address - Phone:704-658-9870
Mailing Address - Fax:704-658-9871
Practice Address - Street 1:521 E PLAZA DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-8071
Practice Address - Country:US
Practice Address - Phone:704-658-9870
Practice Address - Fax:704-658-9871
Is Sole Proprietor?:No
Enumeration Date:2010-05-09
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439953183500000X
NC15655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist