Provider Demographics
NPI:1366950156
Name:PAHL, BRENDA LOUISE (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOUISE
Last Name:PAHL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 CORTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45314-9719
Mailing Address - Country:US
Mailing Address - Phone:419-565-1917
Mailing Address - Fax:
Practice Address - Street 1:251 N MAIN STREET, HSC 234
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:OH
Practice Address - Zip Code:45314-4531
Practice Address - Country:US
Practice Address - Phone:937-766-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03118933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist