Provider Demographics
NPI:1871153056
Name:CHOW, BRENDA
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:CHOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15333 CULVER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3051
Mailing Address - Country:US
Mailing Address - Phone:949-654-2600
Mailing Address - Fax:949-654-2606
Practice Address - Street 1:15333 CULVER DR STE 300
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3051
Practice Address - Country:US
Practice Address - Phone:949-654-2600
Practice Address - Fax:949-654-2606
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist