Provider Demographics
NPI:1548555485
Name:OHEARN, BRENDA (RPH)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:OHEARN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 GRADY COBB RD
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-2822
Mailing Address - Country:US
Mailing Address - Phone:229-524-5565
Mailing Address - Fax:
Practice Address - Street 1:800 BLAKELY ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-5329
Practice Address - Country:US
Practice Address - Phone:229-732-2191
Practice Address - Fax:229-732-5856
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2013-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist