Provider Demographics
NPI:1720480635
Name:UPTON, BRENDA KAY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:KAY
Last Name:UPTON
Suffix:
Gender:F
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:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:WY
Mailing Address - Zip Code:82730-0383
Mailing Address - Country:US
Mailing Address - Phone:307-299-2985
Mailing Address - Fax:
Practice Address - Street 1:2300 S DOUGLAS HIGHWAY
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718
Practice Address - Country:US
Practice Address - Phone:307-686-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist