Provider Demographics
NPI:1447532130
Name:ABATE, BRENDA JEAN (PHARM D)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JEAN
Last Name:ABATE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WATTERS DR
Mailing Address - Street 2:
Mailing Address - City:DWIGHT
Mailing Address - State:IL
Mailing Address - Zip Code:60420-2200
Mailing Address - Country:US
Mailing Address - Phone:815-584-2140
Mailing Address - Fax:
Practice Address - Street 1:106 WATTERS DR
Practice Address - Street 2:
Practice Address - City:DWIGHT
Practice Address - State:IL
Practice Address - Zip Code:60420-2200
Practice Address - Country:US
Practice Address - Phone:815-584-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist