Provider Demographics
NPI:1538364690
Name:MCINTYRE, BRENDA LEE (DPH)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:LEE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-6318
Mailing Address - Country:US
Mailing Address - Phone:615-453-0186
Mailing Address - Fax:
Practice Address - Street 1:1418 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-4824
Practice Address - Country:US
Practice Address - Phone:615-449-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9033183500000X, 1835P0018X
PARP036790L183500000X
WVRP0004916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist