Provider Demographics
NPI:1861785040
Name:DOLENCE, BRIAN DALE (RPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DALE
Last Name:DOLENCE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43971-1248
Mailing Address - Country:US
Mailing Address - Phone:740-859-2449
Mailing Address - Fax:
Practice Address - Street 1:400 PUBLIC RD.
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:OH
Practice Address - Zip Code:43971-1248
Practice Address - Country:US
Practice Address - Phone:740-859-2449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist