Provider Demographics
NPI:1578859773
Name:BRENNAN, JOHN M II (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:BRENNAN
Suffix:II
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 1:886 W STATE ROAD 436
Mailing Address - Street 2:T-0647
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3006
Mailing Address - Country:US
Mailing Address - Phone:407-618-0036
Mailing Address - Fax:407-618-0036
Practice Address - Street 1:886 W STATE ROAD 436
Practice Address - Street 2:T-0647
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3006
Practice Address - Country:US
Practice Address - Phone:407-618-0036
Practice Address - Fax:407-618-0036
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist