1447559141 NPI number — BRIANNE NOHELANI PAMPARO PHARM,D

Table of content: BRIANNE NOHELANI PAMPARO PHARM,D (NPI 1447559141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447559141 NPI number — BRIANNE NOHELANI PAMPARO PHARM,D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAMPARO
Provider First Name:
BRIANNE
Provider Middle Name:
NOHELANI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM,D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YEN
Provider Other First Name:
BRIANNE
Provider Other Middle Name:
NOHELANI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447559141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 RIDGEBRIAR LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWNAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30265-6214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-286-7684
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 TEMPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30263-1328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-253-8562
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH024472 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PH60013989 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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