Provider Demographics
NPI:1366570764
Name:BREWER, DEBORAH LEE (RPH)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LEE
Last Name:BREWER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MAIN STREET
Mailing Address - Street 2:P.O. BOX 187
Mailing Address - City:SANDY HOOK
Mailing Address - State:KY
Mailing Address - Zip Code:41171
Mailing Address - Country:US
Mailing Address - Phone:606-738-5111
Mailing Address - Fax:606-738-4018
Practice Address - Street 1:108 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:KY
Practice Address - Zip Code:41171
Practice Address - Country:US
Practice Address - Phone:606-738-5111
Practice Address - Fax:606-738-4018
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY008280OtherPHARMACIST LICENSE NUMBER