Provider Demographics
NPI:1942817457
Name:CLIFFORD, BRENDAN (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:CLIFFORD
Suffix:
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 1:234 MARKET AVE SW APT 206
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4082
Mailing Address - Country:US
Mailing Address - Phone:585-613-1488
Mailing Address - Fax:
Practice Address - Street 1:8364 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-7805
Practice Address - Country:US
Practice Address - Phone:616-878-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist