Active NPI
Larry Jay Brendle, R.PH.
- Pharmacist
- Melbourne, FL
National Provider Identifier
1154604940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS22779
- Practice address
- 4489 Chastain Dr
Melbourne, FL 32940-1269 - Phone
- (321) 773-4496
- Fax
- (321) 242-2955
- NPI assigned
- Sep 28, 2011
- Last updated
- Sep 28, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS22779 | FL | Primary |
Addresses
Primary practice location
4489 Chastain Dr
Melbourne, FL 32940-1269
Mailing address
4489 Chastain Dr
Melbourne, FL 32940-1269
Phone (321) 773-4496
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS22779 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317168000000",
"number": "1154604940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4489 CHASTAIN DR",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329401269",
"telephone_number": "321-773-4496",
"fax_number": "321-242-2955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4489 CHASTAIN DR",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329401269",
"telephone_number": "321-773-4496",
"fax_number": "321-242-2955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENDLE",
"first_name": "LARRY",
"middle_name": "JAY",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-28",
"last_updated": "2011-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS22779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.