Individual
BRENDON STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1105 RESEARCH CENTER DRIVE ATLANTA SW, ATLANTA, GA 30331
(404) 260-7779
(404) 260-6311
Mailing address
6223 KIRKWOOD PL, DOUGLASVILLE, GA 30134-3876
(314) 709-8788
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
G6C7C4Z4
GA
Other
Enumeration date
11/26/2021
Last updated
11/26/2021
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